Page 13 - Read Online

Neto et al. Mini-invasive Surg 2017;1:6-11 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2016.04
www.misjournal.net
Review Open Access

Preoperative workup, patient selection,

surgical technique and follow-up for a

successful laparoscopic Nissen fundoplication

Rafael Melillo Laurino Neto, Fernando A. M. Herbella
Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Sao Paulo 04037-003, Brazil.

Correspondence to: Dr. Fernando A. M. Herbella, Department of Surgery, Escola Paulista de Medicina, Federal University of Sao Paulo, Rua Diogo
de Faria 1087 cj 301, Sao Paulo 04037-003, Brazil. E-mail: herbella.dcir@epm.br

How to cite this article: Neto RML, Herbella FAM. Preoperative workup, patient selection, surgical technique and follow-up for a successful
laparoscopic Nissen fundoplication. Mini-invasive Surg 2017;1:6-11.
ABSTRACT

Article history: Experienced surgeons have reported excellent results for laparoscopic Nissen fundoplication
Received: 02-10-2016 to treat gastroesophageal reflux disease (GERD). Others, however, associate this operation
Accepted: 14-12-2016 with unacceptable rates of morbidity, mortality and inferior outcomes. Results are certainly
Published: 31-03-2017 linked to an appropriate patient selection, work up, technical details and follow-up. This review
focuses on the proper preoperative workup, patient selection, surgical technique, and follow-
Key words: up for a successful laparoscopic Nissen fundoplication. Certainty of the diagnosis of GERD
Gastroesophageal reflux disease, and the esophageal physiology is essential. An extensive dissection of the esophagus and crus
surgery, in the abdomen and mediastinum, an adequate hiatoplasty, and a short-floppy fundoplication
fundoplication, are important technical points. New onset or persistent symptoms after the operation must be
outcomes carefully studied. Excellent outcomes may be reproducible if a proper preoperative workup,
patient selection, surgical technique and follow-up are rigorously observed.

INTRODUCTION WORKUP

Some experienced surgeons have reported good An extensive esophageal work up with endoscopy,
and excellent results in more than 90% of patients barium esophagraphy, manometry and pH monitoring
submitted to laparoscopic Nissen fundoplication for is mandatory before an antireflux operation. [9,10]
gastroesophageal reflux disease (GERD). [1-4] Others,
however, associate this operation to unacceptable First of all, outcomes will be excellent if GERD is
rates of morbidity, mortality and inferior outcomes. [5] actually present. Thus, the certainty of the correct
Results are certainly linked to an appropriate patient diagnosis is required. Although the diagnosis may
selection, work up, technical details and follow-up. be easy to perform in patients with typical symptoms
[8]
[7]
[6]
and evident alterations in endoscopy as well as pH
This paper focuses on the proper preoperative workup, monitoring, this task may be more difficult in those with
patient selection, surgical technique and follow-up for extra esophageal symptoms and normal tests. This is
a successful laparoscopic Nissen fundoplication. true due to the fact that these tests have a significant
Quick Response Code:
This is an open access article licensed under the terms of Creative Commons Attribution 4.0 International
License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution,
and reproduction in any medium, as long as the original author is credited and the new creations are licensed under the
identical terms.
For reprints contact: service@oaepublish.com

6 © 2017 OAE Publishing Inc. www.oaepublish.com