Laparoscopic Nissen fundoplication in the management of gastroesophageal reflux disease: a single centre experience


  • Shah Touseef Arajmand Department of General Surgery, Mahatma Ghandi Medical College and Research Institute, Pilliayarkuppam, Pondicherry, India
  • Yaqoob Hassan Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Medical College, Srinagar, India
  • Mela Ram Attri Department of General Surgery, Government Medical College, Srinagar, India
  • Nida Shafiq Department of General Surgery, Government Medical College, Srinagar, India



Gastro-oesophageal reflux, Laparoscopy, Nissen fundoplication


Background: Laparoscopic Nissen fundoplication is currently the surgical treatment of choice for gastro-esophageal reflux disease (GERD) in properly selected patients.

Methods: Laparoscopic Nissen fundoplication was performed in 36 patients of GERD, Government Medical College over a period of 2 years. Pre-operative evaluation included baseline investigations and clinical assessment by using GERD Questionnaire and specific investigations i.e., barium esophagram, esophago-gastroduodenoscopy, esophageal manometry and 24 hour ambulatory pH monitoring of the esophagus. All patients underwent laparoscopic Nissen Fundoplication. Patients were evaluated at three months after surgery with symptom scoring questionnaire.

Results: Mean age of patients in our study was 38 years and most common symptoms were heartburn and regurgitation. Four patients (11%) developed complications. The conversion rate to laparotomy was 2.7% (1 patient). Average symptom scores decreased from 10/18 to 0/18 after fundoplication (<0.0001) and all the eight patients who underwent postoperative endoscopy had normal results.

Conclusions: Laparoscopic Nissen’s fundoplication is a safe and effective procedure for GERD, having an acceptable hospital stay with consistently improved short term symptomatic and endoscopic results.

Author Biography

Yaqoob Hassan, Department of General Surgery, Sher-I-Kashmir Institute of Medical Sciences, Medical College, Srinagar, India

Regitrar ,SKIMS medical college ,Department of Surgery


Vakil N, van Zanten SV, Kahrilas P. Global Consensus Group. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101:1900-20.

Pope CE. Acid reflux disorders. N Engl J Med. 1995;331:656-60.

Mittal RK, Balaban DH. The esophagogastric junction. N Engl J Med. 1997;336:924-32.

Mittal RK. The crural diaphragm, an external lower esophageal sphincter: a definitive study. Gastroenterol. 1993;105:1565-7.

Page AJ, Blackshaw LA. An in vitro study of the properties of vagal afferent fibers innervating the ferret esophagus and stomach. J Physiol. 1998;512(Pt 3):907-16.

Mittal RK, Holloway RH, Penagini R, et al. Transient lower esophageal sphincter relaxation. Gastroenterol. 1995;109:601-10.

Trudgill NJ, Riley SA. Transient lower esophageal sphincter relaxations are no more frequent in patients with gastroesophageal reflux disease than in asymptomatic volunteers. Am J Gastroenterol. 2001;96:2569-74.

Bredenoord AJ, Hemmink GJ, Smout AJ. Relationship between gastroesophageal reflux pattern and severity of mucosal damage. Neurogastroenterol Motil. 2009;21:807-12.

Jones MP, Sloan SS, Rabine JC. Hiatal hernia size is the dominant determinant of esophagitis presence and severity in gastroesophageal reflux disease. Am J Gastroenterol. 2001;96;1711-7.

Jones MP, Sloan SS, Jovanovic B. Impaired egress rather than increased access: an important independent predictor of erosive esophagitis. Neurogastroenterol Motil. 2002;14:625-31.

Kahrilas PJ. Supraesophageal complications of reflux disease and hiatal hernia. Am J Med. 2001;111:51-5.

Hetzel DJ, Dent J, Reed WD. Healing and relapse of severe peptic esophagitis after treatment with omeprazole. Gastroenterol. 1988;95:903.

Stein JH, Hoeft S, DeMeester TR. Functional foregut abnormalities in Barrett's esophagus. J Thorac Cardiovasc Surg. 1993;105(1):107-111.

Baker ME, Einstein DM., Herts BR. Gastroesophageal reflux disease: integrating the barium esophagram before and after antireflux surgery. Radiol. 2007;243:329-39.

El-serag HB. Epidemiology of non-erosive reflux disease. Digestion. 2008;78(suppl 1):6-10.

Gyawali CP. High resolution manometry: the Ray Clouse legacy. Neurogastroenterol Motil. 2012;24:2-4.

Hirano I, Zhang Q, Pandolfino JE. Four-day Bravo pH capsule monitoring with and without proton pump inhibitor therapy. Clin Gastroenterol Hepatol. 2005;3:1083-8.

Fischer JE. Fischer's mastery of surgery. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2012.

Ness-Jensen E, Lindam A, Lagergren J. Changes in prevalence, incidence and spontaneous loss of gastro-oesophageal reflux symptoms: a prospective population-based cohort study, the HUNT study. Gut. 2012;61:1390-7.

Li YM, Du J, Zhang H. Epidemiological investigation in outpatients with symptomatic gastroesophageal reflux from the Department of Medicine in Zhejiang Province, east China. J Gastroenterol Hepatol. 2008;23:283-9.

Wong BC. and Kinoshita Y. Systematic review on epidemiology of gastroesophageal reflux disease in Asia. Clin Gastroenterol Hepatol. 2006;4:398-407.

Yamagishi H, Koike T, Ohara S. Prevalence of gastroesophageal reflux symptoms in a large unselected general population in Japan. World J Gastroenterol. 2008;14:1358-64.

Locke GR, Talley NJ, Fett SL. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterol. 1997;112:1448-56.

Nouraie M, Razjouyan H, Assady M. Epidemiology of gastroesophageal reflux symptoms in Tehran, Iran: a population-based telephone survey. Arch Iran Med. 2007;10:289-94.

Nocon M, Labenz J, and Willich SN. Lifestyle factors and symptoms of gastro-oesophageal reflux: a population-based study. Aliment Pharmacol Ther. 2006;23:169-74.

Gotley DC, Smithers BM, Rhodes M. Laparoscopic Nissen fundoplication - 200 consecutive cases. Gut. 1996;38:487-91.

Peters JH, DeMeester TR, Crookes P. The treatment of gastroesophageal reflux disease with laparoscopic Nissen fundoplication: prospective evaluation of 100 patients with typical' symptoms. Ann Surg. 1998;228(1):40-50.

Dunnington GL and DeMeester TR. Outcome effect of adherence to operative principles of Nissen fundoplication by multiple surgeons. The Department of Veterans Affairs Gastroesophageal Reflux Disease Study Group. Am J Surg. 1993;166:654-7.






Original Research Articles