NISSEN FUNDOPLICATION FOR GASTROESOPHAGEAL REFLUX DISEASE: Technical details, long-term outcome, and causes of failures

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Abstract
Nissen fundoplication has recently experienced a renaissance as a cost-effective alternative to lifelong medical treatment in patients with gastroesophageal reflux disease. However, only strict patient selection and adherence to the technical details of the procedure can avoid the side-effects and recurrences that have brought the traditional 'open' procedure into disrepute in the past. The essential technical steps are: division of the short gastric vessels, closure of the hiatus, limiting the length of the wrap to 2 cm, ensuring a loose and floppy fundoplication, and the use of non-absorbable suture material. When these principles are observed, Nissen fundoplication will result in control of reflux symptoms in about 90% of patients for up to 20 years with minimal side-effects.

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