Nissen Fundoplication (Hiatus Hernia Repair)
Nissen fundoplication is the surgical procedure of choice for the treatment of gastroesophageal reflux disease and hiatus hernia. Variations of the technique are applied in specific circumstances. This procedure is only offered when medical therapy fails to control symptoms. In patients with a paraoesophageal hiatus hernia a Nissen is seen as first-line therapy. Five small incisions are made and the gastric fundus (upper part of the stomach) is secured around the lower end of the oesophagus reinforcing the closing function of the lower oesophageal valve mechanism. The oesophageal hiatus is also narrowed down with sutures to prevent recurrent hiatal hernia, in which the fundus slides up through the enlarged oesophageal hiatus of the diaphragm.
Collis Nissen (Hiatus Hernia Repair with Oesophageal Lengthening)
This operation is performed in the setting of a shortened oesophagus. The oesophagus is lengthened by tubular stapling of the stomach and the Nissen fundoplication is then performed around this newly created oesophagus.