Floppy Nissen Fundoplication in Lithuania

The original fundoplication technique as described by Rudolf Nissen in 1955 consisted in wrapping the fundus of the stomach around the esophagus, while leaving the gastrosplenic vessels and the diaphragmatic hiatus intact. Additionally, the vagus nerves were little or not preserved. The basic principles of a fundoplication are: - tension-free repositioning of the gastroesophageal junction (along with 2 cm of lower esophagus in a subphrenic position); - use the gastric fundus to create the fundoplication; - make sure that the resistance generated by the anti-reflux mechanism matches the preoperative assessment of esophageal peristalsis.