Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD) and hiatus hernia. In GERD it is usually performed when medical therapy has failed, but in particular types of hiatus hernia (the paraoesophageal variant), it is the first-line procedure. It is occasionally used as a therapy for refractory achalasia.

The procedure

---

In fundoplication, the fundus (upper part) of the stomach is wrapped around (-plication) the inferior part of the esophagus, preventing the reflux of gastric acid (in GERD) or preventing the sliding of the fundus through the enlarged hiatus in the diaphragm.

The procedure is often done laparoscopically (keyhole surgery).

Complications

---

Complications include gas bloat syndrome, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, and, rarely achalasia. The procedure can also undo itself over time, leading to recurrence of the symptoms. If the symptoms warrant repeated surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection. Some patients experience severe diarrhea after this surgery, which some health care professionals refer to as IBS.

History

---

Dr. Rudolph Nissen first performed the procedure in 1951, and the procedure therefore bears his name.

External links

---

• FUNDO, a page on fundoplication in children with reflux disease.
• Laparoscopy teaching site (WARNING: contains surgery footage).

Surgery | Gastroenterology