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Laparoscopic Nissen fundoplication for GERD

It is a minimally-invasive procedure that is considered standard surgical technique to treatGERD. The procedure involves reduction of the hiatal hernia, reconstruction of the esophageal hiatus and reinforcement of the lower esophageal sphincter to relieve GERD.The surgery is performed with an aim to strengthen the valve between the esophagus and stomach so as to stop the acid from coming back into the esophagus, allowing the esophagus to heal.
Indications for Laparoscopic Nissen fundoplication
Severe and chronic esophageal reflux that is not relieved by other medical treatments
GERD patients with no previous abdominal surgery
GERD patients with small hiatal hernias
Patients who experience symptoms of reflux when lying down
Patients with extra-esophageal manifestations
Juvenile esophagitis
Procedure:
The procedure involves laparoscopic construction of a new “valve” between the oesophagus and the stomach either through abdomen or through chest. The surgeon uses a trocar to gain access and insert laparoscope to the abdomen. This gives a magnified view of the patient’s internal organs on a television monitor to the surgeon. Four additional trocars are also inserted to accommodate special instrumentation. Now the real procedure is performed by wrapping the upper curve of the stomach (the fundus) around the esophagus. This arrangement is sewn to allow the passage of the lower portion of the esophagus through a small tunnel of stomach muscle. This produces a new valve. Hiatus hernia is also repaired simultaneously.
Advantages of Laparoscopic Nissen fundoplication for GERD:
Superior long-term outcomes
Less painful
Less scarring
Cost effective
Improved cosmesis
Reduced morbidity
Decreased hospital stay
Decreased respiratory and other complications
Faster recovery

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