In 1956 Rudolph Nissen described a technique for treating gastroesophageal reflux by folding the stomach up and around the lower esophagus, and called it a 'Gastric Fundoplication.' The procedure has changed over 50 years, most notably when it went from an open surgery requiring a long midline incision to a laparoscopic procedure done through 5 or 6 small incisions. Laparoscopy significantly improves recovery time and lessens postoperative pain, while providing an excellent surgical repair.

The goal of a gastric fundoplication is to restore the normal competency of the gastroesophageal junction by:
-Restoring the oblique angle at which the esophagus enters the stomach, creating a one-way flap valve.
-Increasing the resting pressure of the lower esophageal sphincter to normal levels (the high pressure zone at the end of the esophagus that relaxes when you swallow and then should tighten up afterwards to prevent reflux).
-Preventing shortening of the lower esophageal sphincter as the stomach distends, keeping the valve more competent.
-Repairing the opening in the diaphragm through which the esophagus comes - the diaphragmatic hiatus - which is often enlarged in patients with severe gastroesophageal reflux.

We have performed over 1200 laparoscopic fundoplications since 1992. We were among the first surgeons in Colorado to perform this procedure. Our team has found that this operation provides excellent and durable results.

Improving Our Results:
We are continually striving to improve our results. We found that, when patients had a mechanical breakdown of the procedure, the hiatal hernia repair was almost always at fault. Since 2007 we have been using a biologic patch to reinforce hiatal hernia repairs. This patch allows for a patient's own tissue to grow into the patch as the patch gradually reabsorbs. This increases the overall strength of the repair considerably. No permanent foreign body is left behind.The biologic material is replaced by the patient's own native tissues to form a stronger bond than sutures alone. Studies have shown this decreases the risk of breakdown of the hiatal hernia repair by over 70%; and our experience as of October 2008 would confirm the benefit of this addition.
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How long will the surgery last?
The laparoscopic Nissen fundoplication was first performed in 1990, and studies evaluating its long-term effectiveness are now available. Most of these studies look at recurrent reflux symptoms, patient satisfaction with the procedure, and the need for restarting medications as indicators of success. A few studies have reported more objective information such as results of pH testing or barium swallow. These studies indicate that patients have very little recurrent heartburn, and over 90% are very satisfied with the surgery. Some patients are back on acid-suppressive medication (5-30% in various studies). Interestingly, only 1 in 4 patients who restarts anti-acid medication actually has documented GERD and probably do not need it. Many of these patients report no perceived benefit to taking the acid-suppressive medication. For this reason we encourage postoperative patients to come see us if they think they are having recurrent reflux, to prevent needless use of medication.