Overview
Rebuilding the valve between stomach and esophagus.
Nissen fundoplication is the most effective surgical operation for chronic acid reflux. In patients whose anti-reflux valve — the lower esophageal sphincter — has weakened or whose stomach has migrated up through the diaphragm into the chest (hiatal hernia), the result is a steady upward flow of acid that medication can dampen but rarely eliminate. The Nissen restores the valve by wrapping the upper portion of the stomach (the fundus) 360 degrees around the lower esophagus, recreating a one-way mechanism that lets food go down and keeps acid from coming up.
We perform the operation robotically through five tiny incisions. About 85–90% of carefully selected patients have durable, satisfactory reflux control years after surgery. The vast majority stop their PPI medications. The Nissen is best for patients with normal esophageal motility on testing; patients with weak or disordered swallowing are usually better served by a partial (Toupet) wrap. The right operation for the right anatomy is the difference between a great outcome and a difficult one — which is why every patient gets EGD, manometry, and a pH study before surgery.
Who is a candidate?
Adults with documented pathologic reflux (confirmed by pH testing) and normal esophageal motility are excellent candidates for Nissen fundoplication. We also offer it to patients with large or symptomatic hiatal hernias, to those with Barrett's esophagus who want durable reflux control, and to patients with regurgitation despite maximal medication. Patients with severely impaired esophageal motility, scleroderma, or significant swallowing problems are usually steered toward a partial Toupet wrap instead. We do not perform fundoplication for atypical reflux symptoms unless pH testing confirms acid as the cause.
How we perform it
Under general anesthesia, five small incisions are placed in the upper abdomen. The hiatal hernia is reduced — the stomach is brought back down out of the chest. The crura, the muscular pillars of the diaphragm around the esophagus, are reapproximated with sutures to close the widened opening. Mesh reinforcement is added selectively for very large defects. The short gastric vessels are divided to fully mobilize the fundus, which is then wrapped 360° around the lower esophagus over a calibrating bougie and secured with permanent sutures. The whole operation takes 90–150 minutes.
Recovery
Most patients spend one night in the hospital. You will walk the evening of surgery and start sips of clear liquid. The diet advances over six weeks — full liquids the first week, soft foods the second through fourth, then solids — to give the wrap time to settle without strain. Some bloating, gas, and difficulty belching are normal in the first weeks and almost always improve. Most patients are off PPIs at discharge. Desk work resumes at 7–10 days, full activity at 2–3 weeks. Follow-up at 2 weeks, 3 months, and 1 year in our Coral Springs office.
Why Florida Surgical
Foregut surgery is where small technical decisions become long-term outcomes. The tightness of the wrap, the placement of the crural sutures, the choice between full and partial fundoplication — these are judgment calls that depend on careful pre-operative testing and meaningful experience. Dr. Shaw and Dr. Decio have completed advanced foregut training and personally perform every step of testing and surgery. We use the robotic platform routinely for fundoplication, where its wristed instruments and 3D view allow precise dissection around the diaphragm and esophagus.
Frequently asked questions
How effective is Nissen fundoplication?
In carefully selected patients, approximately 85–90% have durable, satisfactory reflux control at 10 years. Most stop their PPI medications entirely. Outcomes are best when the pre-operative workup confirms pathologic reflux and normal esophageal motility.
Can I burp or vomit after a Nissen?
Most patients can burp and vomit normally after the first few weeks of swelling subside. The wrap may make belching feel different — sometimes more effortful — and excessive carbonation can cause bloating ("gas bloat syndrome"). We calibrate the wrap intraoperatively to allow normal physiology.
What is the difference between Nissen and Toupet?
A Nissen wraps the fundus 360° around the lower esophagus. A Toupet wraps it 270° posteriorly, leaving the front partially open. Nissen offers slightly better reflux control; Toupet is gentler on swallowing and is the right choice for patients with weak esophageal motility. Your manometry guides the decision.
Is the operation reversible?
Yes. If significant problems develop — persistent swallowing difficulty, wrap migration, or wrap failure — the wrap can be revised or taken down. Reoperation is uncommon, perhaps 5% of patients within a decade.
Do I need testing before surgery?
Yes — every patient gets an upper endoscopy (EGD), a high-resolution esophageal manometry, and a 48-hour Bravo pH study before surgery. These three tests confirm the diagnosis, rule out other conditions, and determine whether a full Nissen or partial Toupet is the correct operation.