A Modified Technique to Create a Standardized Floppy Nissen Fundoplication Without a Bougie

Area of Science:

• Gastroenterology
• Surgical Innovation
• Reflux Management

Background:

• Nissen fundoplication is a common treatment for gastroesophageal reflux disease (GERD).
• Standard fundoplication can lead to persistent GERD or dysphagia if the gastroesophageal junction size is incorrect.
• Using a bougie to size the junction increases perforation risk.

Purpose of the Study:

• To describe a modified, standardized Nissen fundoplication technique that avoids bougie use.
• To evaluate the initial safety and efficacy of this new surgical approach.

Main Methods:

• A novel technique involving three marking sutures on the gastric fundus, forming an equilateral triangle, was employed.
• The triangle's size dictates the fundoplication diameter, aiming for optimal patency and minimal rotation.

Main Results:

• Fifteen patients underwent the modified procedure with no complications.
• Mean operative time was 69.5 minutes; no early dysphagia was reported.
• Mean hospital stay was 1.3 days, with excellent quality of life after one year.

Conclusions:

• The modified standardized Nissen fundoplication appears safe and potentially reduces postoperative dysphagia.
• Excellent long-term quality of life was observed.
• Further large-scale prospective studies are needed to confirm efficacy and reproducibility.