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Laparoscopic Nissen fundoplication: the "right posterior" approach
Attila Csendes1, Patricio Burdiles, Owen Korn
1Department of Surgery, University Hospital, Santiago, Chile. acsendes@machi.med.uchile.cl
Summary
This study details the laparoscopic Nissen fundoplication surgical technique for severe chronic pathologic reflux. The described approach demonstrated high success rates and minimal complications in 225 patients.
Area of Science:
- Gastroenterology
- Surgical Techniques
- Reflux Management
Background:
- Severe chronic pathologic reflux significantly impacts patient quality of life.
- Effective surgical interventions are crucial for managing refractory gastroesophageal reflux disease.
Purpose of the Study:
- To describe the detailed steps of a specific laparoscopic Nissen fundoplication technique.
- To evaluate the safety and efficacy of this surgical approach in patients with severe chronic pathologic reflux.
Main Methods:
- Detailed description of a laparoscopic Nissen fundoplication including "right" and "posterior" approaches.
- Dissection of the esophagogastric junction, management of vagal trunks, division of short gastric vessels, and creation of a 360-degree fundoplication.
- Anterior fundophrenopexy as a final step.
Main Results:
- The technique was applied to 225 patients with severe chronic pathologic reflux.
- A low conversion rate (1.3%), no mortality, and only one significant postoperative complication were observed.
- Excellent or good results were achieved in 85% of patients at a 5-year follow-up, with fair or poor results in 15%.
Conclusions:
- The described laparoscopic Nissen fundoplication is a safe and effective procedure for severe chronic pathologic reflux.
- The technique offers favorable long-term outcomes with a high rate of patient satisfaction.
- Minimizing vagal injury and ensuring a symmetric fundoplication are key elements for success.