Laparoscopic antireflux surgery

Rudolph Nissen popularized a fundoplication that bears his name in 1956, following the discovery that a fundal patch, used to reinforce an esophageal suture line, also corrected gastroesophageal reflux. In 1991, two almost simultaneous publications were released describing the adaption of Nissen‘s technique laparoscopically. The principles of the operation closely followed the open technique, with division of the short gastric vessels, posterior closure of the diaphragmatic hiatus, and creation of a 1-2 cm 360-degree wrap, calibrated by at least a 52 Fr bougie. Although the initial reports included very good levels of reflux control, adverse effects-such as dysphagia, inability to belch, gas bloat, and increased flatulence-were not uncommon.