Hiatus Hernia repair and Nissen Fundoplication
These procedures are used to repair a sliding hiatus hernia or to treat some forms of intractable gastro-oesophageal reflux disease. There are many different types of wrap described. Nissen’s is a 360˚ wrap of the fundus around the oesophagus. Prior to undergoing your procedure, various investigations need to be undertaken. Preoperative upper gastrointestinal endoscopy required to assess for oesophagitis or the presence of hiatus hernia.
The procedure is most commonly performed laparoscopically. The right and left crura are dissected and circumferential dissection of the oesophagus is performed.
The hiatus is then closed with sutures. The short gastric vessels may be divided to improve mobilization of the fundus. In Nissen’s procedure the mobilized fundus is wrapped 360˚ around the oesophagus by passing it through the posterior window behind the oesophagus. The wrap is then secured in place on the anterior oesophagus with a varying number of sutures.