Laparoscopic floppy Nissen fundoplication

Good results for antireflux surgery are obtained when proper patients are selected, trained surgeons perform the operation, and proper techniques are used. As our prior results showed higher rates of dysphagia without fundus mobilization (Nissen-Rossetti fundoplication), we now perform complete mobilization on all patients. Full fundus mobilization requires take-down of the short gastric vessels to reveal the base of the left crus, take-down of all posterior gastropancreatic adhesions and the peritoneal fold that is cauded to the crus and superior to the pancreas. Proper division of these attachments will allow an untethered fundoplication and may reduce the risk of dysphagia and slip of the fundoplication onto the stomach.