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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.
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 achalasia, dysphagia (trouble swallowing) and excessive scarring. 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.
History
Dr. Rudolph Nissen first performed the procedure in 1951, and the procedure therefore bears his name.
External links
- FUNDO (http://www.geocities.com/fundofamilies/index3.html), a page on fundoplication in children with reflux disease.
- Laparoscopy teaching site (http://www.laparoscopy.com/pictures/lap_niss.html) (WARNING: contains surgery footage).
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