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What is a Nissen fundoplication?
The fundus of the stomach is mobilized and put to wrap around the esophagus at the esophago-gastric junction in order to treat a hiatal hernia with reflux esophagitis.
How is it done?
It is done by using a laparoscopic technique. The upper part of the stomach is dissected free from the spleen. The fundus is then wrapped 360o around the esophagus and is fixed with a few stitches. The wide hiatus of the diaphragm that is the cause of the hernia is then sutured to make it narrower.
Why is it done?
It is indicated in patient who is proved to have a hiatal hernia with evidence of inflammation in the lower esophagus and has symptom of heartburn.
Risks & complications
It is done under general anesthesia. It thus harbors the risk of anesthesia. Surgical complications may occur, for example, bleeding from the spleen or injury to the intestine, but these are rare. If complication occurs, it will have to be managed accordingly.
Alternatives
Usually the patient will be treated by appropriate medication to alleviate his symptom first. If medical treatment fails, then he is referred for surgery.
Candidate eligibility
Patients with diagnosis of hiatal hernia with reflux esophagitis, who are healthy enough to withstand a major surgery under general anesthesia, are eligible to have this procedure.
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