title: Laparoscopic floppy Nissen fundoplication: 16 years of experience from the historical clinic of Rudolph Nissen.
abstract: OBJECTIVE
  Since its original description in 1956 by Rudolph Nissen, minor changes were made in technical details of Nissen fundoplication. After the introduction of laparoscopic fundoplication, in order to reduce the rate of complications, some technical modifications led to the development of 'floppy' Nissen fundoplication.
  
  
  METHODS
  From August 1993 to August 2009, laparoscopic Nissen fundoplication was performed on 2100 patients, 17 of whom underwent classical and 2083 underwent floppy fundoplication. All the operations were performed by the same surgical team. Preoperative work-up included 24-h pH monitoring, esophagogastroduodenoscopy and barium cineradiography. Esophageal manometry was not performed due to the physical impossibility of this tool at our clinic. Key steps of the operation were dissection of the hepatogastric and Laimer's ligament, dissection and closure of the hiatus, and short, floppy Nissen fundoplication. Phrenoesophageal ligament was divided to obtain at least of 4cm of an abdominal esophagus.
  
  
  RESULTS
  On the follow-up, dysphagia lasted for 1 month in 5.2% (110), between 1-3 months in 0.7% (16) and more than 3 months in 0.1% (3) of patients. Mortality was seen in 1 (0.05%) patient, and it was related to fatal pulmonary vein injury during perioperative bougienage.
  
  
  CONCLUSIONS
  Laparoscopic floppy Nissen fundoplication seems to be a safe and feasible technique for surgical treatment of gastroesophageal reflux disease.
authors.affiliation: Istanbul University, Department of General Surgery, Istanbul, Turkey.
authors.forename: Erhun
authors.initials: E
authors.lastname: Eyuboglu
authors.forename: Turgut
authors.initials: T
authors.lastname: Ipek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014421:Turkey