This video demonstrate Nissen fundoplication, also referred to as a Lap Nissen, is a laparoscopic procedure performed for patients with gastroesophageal reflux disease (GERD). Many patients with reflux can be treated with medicines to decrease acid production in the stomach.

Nissen fundoplication is one of the most established surgical procedures for the treatment of gastroesophageal reflux disease (GERD). It involves wrapping the gastric fundus around the lower end of the esophagus to reinforce the lower esophageal sphincter (LES), thereby preventing reflux of gastric contents into the esophagus. With the evolution of minimal access surgery, laparoscopic Nissen fundoplication has become the gold standard due to reduced postoperative pain, faster recovery, and excellent long-term outcomes. At World Laparoscopy Hospital (WLH), this procedure is performed using advanced laparoscopic techniques while simultaneously serving as a key component of surgical training for global surgeons.

Historical Background and Concept

Nissen fundoplication was originally described as a 360-degree wrap procedure designed to recreate the anti-reflux barrier at the gastroesophageal junction. Today, it is among the most commonly performed anti-reflux surgeries worldwide. The laparoscopic approach has further increased its acceptance due to improved patient comfort and faster rehabilitation.

Indications of Nissen Fundoplication

Nissen fundoplication is generally recommended in patients with:

• Chronic GERD not responding to medical therapy

• Complications of GERD such as esophagitis or Barrett’s esophagus

• Hiatal hernia associated with reflux

• Young patients requiring lifelong proton pump inhibitors

• Extra-esophageal reflux manifestations

Surgery is usually offered only after objective confirmation of reflux disease through endoscopy, manometry, or pH monitoring.

Preoperative Evaluation

At specialized centers like WLH, preoperative evaluation typically includes:

• Upper GI endoscopy

• Esophageal manometry

• 24-hour pH monitoring

• Barium swallow imaging

• Clinical symptom scoring

These investigations help ensure proper patient selection and optimize outcomes.

Surgical Technique (Laparoscopic Nissen Fundoplication)

The standard operative steps include:

1. Patient positioning and trocar placement

2. Liver retraction

3. Division of hepatogastric ligament

4. Dissection of esophageal hiatus and crura

5. Mobilization of stomach fundus

6. Division of short gastric vessels

7. Retro-esophageal window creation

8. Hiatal closure (cruroplasty)

9. Formation of 360° fundic wrap around esophagus

10. Fixation of wrap to prevent migration

The wrap is usually kept “floppy” to avoid postoperative dysphagia, and calibration using a bougie is commonly performed.

Advantages of Laparoscopic Approach

Compared with open surgery, laparoscopic Nissen fundoplication offers:

• Smaller incisions

• Reduced postoperative pain

• Shorter hospital stay

• Faster return to daily activities

• Better cosmetic results

Patients can often resume light activity within days and normal routine within 1–2 weeks.

Clinical Outcomes and Success Rate

Clinical studies demonstrate excellent results:

• Good to excellent outcomes in 85–95% of patients

• Patient satisfaction rates often above 90%

• Long-term relief from reflux symptoms in most patients

• Recurrence rates usually below 10%

These results confirm that laparoscopic Nissen fundoplication is highly effective when performed in well-selected patients.

Complications and Side Effects

Although safe, potential complications include:

Early complications

• Bleeding

• Esophageal or gastric perforation

• Pneumothorax

• Infection

Late complications

• Dysphagia

• Gas-bloat syndrome

• Wrap migration or herniation

• Recurrent reflux

Overall complication rates range from 5–10%, depending on definitions and patient factors.

Postoperative Care

Postoperative care typically includes:

• Liquid diet → soft diet → normal diet progression

• Avoidance of large meals initially

• Early ambulation

• Proton pump inhibitors if needed temporarily

• Follow-up endoscopy or imaging when indicated

Most temporary swallowing difficulty improves within weeks.

Role of World Laparoscopy Hospital

World Laparoscopy Hospital is internationally recognized for:

• Advanced laparoscopic anti-reflux surgery

• Hands-on surgical training for global surgeons

• Evidence-based surgical protocols

• Emphasis on patient safety and precision

At WLH, surgeons are trained to perform fundoplication using standardized laparoscopic steps, simulation training, and supervised live surgery exposure, ensuring optimal patient outcomes and surgical excellence.

Conclusion

Nissen fundoplication remains one of the most reliable surgical treatments for GERD, especially in patients with refractory symptoms or anatomical defects like hiatal hernia. The laparoscopic approach has revolutionized the procedure by improving recovery and maintaining excellent long-term success rates. At World Laparoscopy Hospital, this procedure represents both a therapeutic solution for patients and a vital learning opportunity for surgeons worldwide. With proper patient selection, meticulous surgical technique, and structured postoperative care, laparoscopic Nissen fundoplication continues to provide durable relief from reflux disease and significantly improves quality of life.