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Jul02
LAPAROSCOPIC NISSEN FUNDOPLICATION
Gastro Esophageal Reflux Disease (GERD ) is a very common digestive disorder. Medical therapy , involving acid suppression and promotility agents are very effective for a majority of these patients but a small number of these patients do not get complete relief. Laparoscopic fundoplication is a procedure performed for patients with symptomatic GERD refractory to medical management and that which is associated with hiatal hernia .The problem lies at the junction of the esophagus and stomach where a muscular valve should prevent acid from backing upwards. If this sphincter mechanism fails, acid is free to reflux up into the food pipe and cause damage. The surgery basically augments this sphincter by wrapping a portion of the stomach known as the fundus around the lower esophageal sphincter.Before the laparoscopic approach was developed, this surgery required a large incision and the hospital stay was long. Laparoscopic fundoplication is a safe procedure, and provides less post operative morbidity in experienced hands.The fundus of the stomach which is on the left of the esophagus is wrapped around the back of the esophagus until it is once again in front of this structure.The portion of the fundus that is now on the right side of the esophagus is sutured to the portion on the left side to keep the wrap in place.The fundoplication resembles a buttoned shirt collar. The collar is the fundus wrap, and the neck represents the esophagus imbricated into the wrap.This has the effect of creating a one way valve in the esophagus to allow food to pass into the stomach, and prevent reflux of gastric acid.


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