General Surgery

Nissen Fundoplication (Laparoscopic)

OPERATION: Laparoscopic Nissen Fundoplication
ANAESTHETIC: General anaesthesia
POSITION: Supine, legs split, head-up (reverse Trendelenburg). Surgeon between legs.

INDICATION:
Gastro-oesophageal reflux disease, medically refractory / patient preference. [Hiatus hernia confirmed on endoscopy / barium swallow / CT].

PROCEDURE:
WHO Checklist performed. Five ports inserted: one 10mm umbilical camera port, two 5mm right-sided ports (including one for liver retractor), one 5mm left inferior port, one 12mm left superior working port.

Left lobe of liver elevated with Nathanson / fan retractor. Gastrohepatic ligament divided preserving hepatic branch of vagus where possible. Right crus identified. Phreno-oesophageal ligament divided with preservation of anterior vagus nerve. Posterior vagus nerve identified. Oesophagus encircled with Penrose drain and retracted anteriorly to define the posterior window.

Short gastric arteries divided using ultrasonic dissection to fully mobilise the gastric fundus. Crura approximated posterior to oesophagus using 2/0 non-absorbable sutures [with 40–52 Fr bougie in situ to calibrate wrap]. [Anterior cruroplasty sutures placed if required].

Gastric fundus passed posterior to oesophagus. Tension-free posterior 360-degree wrap fashioned using 2/0 non-absorbable sutures × [2–3]. Wrap confirmed floppy — able to pass instrument between wrap and oesophagus. Bougie removed.

Pneumoperitoneum released. Port sites closed.

FINDINGS:
[Describe hiatus hernia size / oesophageal length / degree of oesophagitis]. Fundus mobilised without tension.

EBL: Minimal. COMPLICATIONS: None.

POST-OPERATIVE INSTRUCTIONS:
Soft diet for 4–6 weeks. Avoid carbonated drinks. Outpatient review at 6 weeks.