MODIFIED NISSEN FUNDOPLICATION IN THE TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE

Twenty-five consecutive patients underwent a primary modified Nissen f undoplication for gastroesophageal reflux disease. According to this p rocedure, an increase of the diameter of the gastric wrap to a comfort able passage of the surgeon's index finger between oesophagus and gast ric wrap was obtained, while the length of the gastric wrap was 1.0 cm . The fixation of the wrap on the anterior wall of the oesophagus was done at the level of the mucosal cardia 1.0 cm above the gastroesophag eal junction strengthened by four mesh pledgets. Two more stitches bet ween the seromuscular layer of the gastric fundus and the oesophageal musculature were placed to prevent reduction of created oesophagogastr ic intussusception. The results of this modified Nissen procedure are excellent during the early postoperative follow-up period, ranging fro m 10 to 45 months and averaging 26 months.