Nissen-Rossetti antireflux fundoplication (open procedure)

The modern era of antireflux surgery began in the 1950s with the description of fundoplication by Nissen. Nissen's original procedure entailed a 360-degree wrap of the fundus of the stomach around the distal esophagus. This was constructed using the anterior and posterior walls of the fundus, without dividing the short gastric blood vessels. Subsequently, a number of modifications have been described, with the aim of either simplifying the performance of the procedure, reducing perioperative morbidity, or preventing side effects. In the mid-1960s, Nissen and Rossetti modified Nissen's original technique so that the anterior wall of the fundus alone was used to construct the 360-degree wrap. Subsequently, DeMeester and Donohue advocated division of the short gastric blood vessels to enable the construction of a “floppy” Nissen fundoplication.
More recently, however, the results from six prospective randomized trials of Nissen fundoplication with and without division of the short gastric vessels have demonstrated that division of the short gastric blood vessels is not necessary. Equivalent reflux control and a similar prevalence of dysphagia at follow-up of up to 10 years are achieved without routinely dividing these vessels. Furthermore, the randomized trials have shown that dividing the vessels actually increases the complexity of the procedure, and produced a poorer outcome in three of the six trials due to an increase in the incidence of bloating symptoms following vessel division.