Nissenfundoplication
If medication for gastro-esophageal reflux disease (GERD) fails, or if the patient doesn't want to use lifelong medication, an operation according to Nissen can be a good operative alternative. In this operation reflux of the acid contents of the stomach is prevented by folding the upper part of the stomach as a cuff around the esophagus. In this way a valve is constructed that prohibits the reflux.
An example of the laparoscopic operation is given, partly schematic
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By means of several ports, mostly 5, the operation is performed (1). The too wide passage through the diafragm is tightened (2) and then the cuff is being constructed (3).
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In 4 the passage of the esophagus through the diafragm can be seen. The esophagus is in the upper part of the picture and is being held by a sling. In 5 the suturing and tightening of the passage is shown and in 6 it is completed.
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Then the upper part of the stomach is led behind the esophagus (7,8) and sutured to its front side (9,10).
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The drawing (11) shows the situation afterwards. In the right upper part the liver and the gallbladder (the green thing) are held apart, in the middle you can see the stomach with its cuff and at left the spleen is visible. In 12 the immediate postoperative situation is shown with five little scars.