Nissen fundoplication

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Fundoplication is an operation used in the treatment of intractable oesophageal reflux. It involves wrapping the fundus of the stomach around the lower part of the oesophagus such that is maintains the lower part of the oesophagus in the abdominal cavity.

The current standard surgical technique for GORD is a laparoscopic fundoplication involving:

  • reduction of the hiatal hernia (if present),
  • partially closing the dilated diaphragmatic hiatus to approximate its normal size,
  • and bolstering the LES by encircling it either partially (Dor 180ø, Toupet 270ø) or completely (Nissen 360ø) with the mobilized gastric fundus

  • complications following antireflux surgery are common, particularly following laparoscopic fundoplication
    • include fundoplication failure, dysphagia related to stenosis, as well as various functional gastrointestinal symptoms (1)

  • Nissen fundoplication:
    • laparoscopic Nissen fundoplication is a 360-degree fundoplication after crural closure, and aims to circumferentially plicate the stomach to the oesophagus in order to strengthen the oesophagogastric junction valve
    • multicenter trial enrolled 554 patients with chronic GORD who had initially responded to PPIs and randomized them to either laparoscopic Nissen fundoplication or 20-40 mg esomeprazole (2)
      • estimated remission rates at 5 years, defined as not needing a PPI in the surgical group or adequately controlled symptoms in the PPI group, were 92% with PPIs and 85% with fundoplication (P=0.048)

Reference:

  • Yadpatlati R et al. Complications of Antireflux Surgery.Am J Gastroenterol. 2018 Aug; 113(8): 1137–1147.
  • Galmiche JP, Hatlebakk J, Attwood S, et al, LOTUS Trial Collaborators. Laparoscopic antireflux surgery vs esomeprazole treatment for chronic GERD: the LOTUS randomized clinical trial. JAMA 2011;305:1969-77. doi:10.1001/jama.2011.626

Last edited 11/2020 and last reviewed 11/2020

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