title: Laparoscopic tailored Nissen fundoplication.
abstract: BACKGROUND
  It is difficult sometimes to determine the suture points for proper Nissen fundoplication under laparoscopy. We introduce a new procedure to define the suture points in Laparoscopic Nissen fundoplication (LNF).
  
  
  METHODS
  After dissection of the hiatus and mobilization of the fundus, the circumference of the esophagus c is measured at a point 2-cm cranial from the esophagogastric junction over the 52-Fr bougie. The inner diameter of the fundoplication is calculated based on the esophageal diameter. To create a 2-cm fundoplication in which the greater curvature of the gastric fundus is moved straight toward the cranial side without any twist, we located points a and b, which correspond to the top of the left and right suture positions on fundoplication, respectively. Approximately 2 cm of floppy Nissen is constructed by suturing caudally with intervals of ~1 cm.
  
  
  METHODS
  A total of 20 patients (3 men, 17 women, mean age, 64.5 years) with gastroesophageal reflux disease and/or hiatal hernia underwent LNF using this procedure.
  
  
  RESULTS
  LNF was successful in all 20 patients. There were no complications except for mild dysphagia in two patients, which disappeared within 3 weeks. Improvement of the symptom scores for heartburn, regurgitation, and dysphagia was observed in all patients. The evaluation of the fundoplication by the morphologic scores was quite satisfactory. During a median follow-up period of 30 months, 19 patients exhibited no recurrence, and 1 patient had a mild recurrence but was controlled by PPI on demand.
  
  
  CONCLUSIONS
  Our new procedure is very safe and effective to create a proper Nissen fundoplication. In addition, our preliminary findings highlight the feasibility of precise localization of suture points without the need to measure the circumference of the esophagus and that LNF could be performed without a bougie.
authors.affiliation: Department of Surgery, Fukuyama City Hospital, Fukuyama City, Hiroshima, 721-8511, Japan. ihitoshi@saturn.dti.ne.jp
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Idani
authors.forename: Shinya
authors.initials: S
authors.lastname: Asami
authors.forename: Takashi
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Kubo
authors.forename: Takayuki
authors.initials: T
authors.lastname: Iwamoto
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kin
mesh_terms: D000368:Aged; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013536:Suture Techniques; D016896:Treatment Outcome