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Laparoscopic Nissen Fundoplication (360-Degree Wrap)

A minimally invasive antireflux operation in which the gastric fundus is mobilized and wrapped 360 degrees around the distal esophagus to recreate the lower esophageal sphincter mechanism in patients with severe gastroesophageal reflux disease.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Laparoscopic Nissen Fundoplication (360-Degree Wrap)?

Laparoscopic Nissen fundoplication is performed through five small abdominal ports; the operation includes hiatal dissection, mobilization of the gastric fundus by division of the short gastric vessels, posterior crural repair, and creation of a short floppy 360-degree wrap of fundus around the distal esophagus over a calibrating bougie.

Indications include proton-pump inhibitor refractory GERD, large symptomatic hiatal hernias, severe regurgitation despite medical therapy, esophagitis-induced strictures, severe extra-esophageal symptoms (laryngitis, asthma), and patient preference for definitive treatment over lifelong PPI use.

Long-term results in carefully selected patients show 80 to 90 percent durable symptom control at 10 years, with main side effects of transient dysphagia, gas-bloat syndrome, and inability to belch; appropriate preoperative work-up with manometry and pH-impedance testing is essential.

Symptoms

Persistent or refractory heartburn and regurgitation despite optimized PPI therapy
Volume regurgitation, especially nocturnal, with cough or aspiration
Large hiatal or paraesophageal hernia with associated symptoms
Severe extra-esophageal manifestations: chronic laryngitis, asthma exacerbations, or dental erosion
Esophagitis-induced strictures or Barrett's esophagus with abnormal acid exposure
Patient choice to avoid lifelong proton-pump inhibitor therapy

Risk Factors

Severe esophageal dysmotility or achalasia (relative contraindication for 360-degree wrap)
Morbid obesity (BMI greater than 35) — bariatric surgery may be more appropriate
Previous foregut or hiatal surgery (technical complexity)
Significant cardiopulmonary comorbidity affecting tolerance of pneumoperitoneum
Connective tissue disorders such as scleroderma involving the esophagus

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • GERD symptoms that fail to respond to twice-daily proton-pump inhibitor therapy after 8 to 12 weeks
  • Recurrent aspiration pneumonia, severe regurgitation, or laryngeal symptoms attributed to reflux
  • Large hiatal hernia identified on endoscopy or imaging with symptoms or anemia
  • Severe nocturnal regurgitation interfering with sleep or causing aspiration
  • Postoperative new dysphagia, severe gas-bloat, or recurrent reflux that fails dietary modification

Treatment Methods

01
Comprehensive preoperative work-up including upper endoscopy, esophageal manometry, and 24-hour pH-impedance monitoring to confirm acid exposure and rule out motility disorders
02
Laparoscopic mobilization of the esophagus, complete hiatal dissection, and posterior crural repair with non-absorbable sutures
03
Division of short gastric vessels and creation of a tension-free 360-degree wrap (typically 2 to 3 cm long) over a 50 to 60 French bougie
04
Postoperative diet progression from liquids to soft food over 4 to 6 weeks, with proton-pump inhibitor cessation in most patients
05
Long-term follow-up to monitor for recurrence, dysphagia, and the need for endoscopic dilation or revisional surgery in 5 to 10 percent of patients

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.