Nissen fundoplication
Summary
A surgical procedure for GERD where the gastric fundus is wrapped 360 degrees around the lower esophageal sphincter. Gold-standard surgical treatment for GERD refractory to medical management.
Detail
The gastric fundus is wrapped completely around the distal esophagus, creating a valvular mechanism that increases LES pressure. Indicated for GERD persisting despite optimal PPI therapy, or patients unable to tolerate long-term medications. Success rate ~92%. Complications: gas bloat syndrome (10-15%), dysphagia, vagus nerve injury. Patients with severe motility disorders may be better candidates for partial (Dor/Toupet) wraps.
Sources
- First Aid for the USMLE Step 1
- Robbins Basic Pathology
- Harrison's Principles of Internal Medicine
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