Gastroesophageal reflux disorder or GERD is one of the most common diseases of the GI tract in the United States. It occurs due to the backflow of stomach ingredients (fluids and ingested food), where bile or stomach acid irritates the lining of the esophagus, causing heartburn. When it comes to treating GERD by surgical means, fundoplication is the procedure that most bariatric doctors prescribe. If you are a resident of Dallas with a GERD diagnosis, you can consult an experienced bariatric doctor for antireflux surgery at DFW Bariatrics and General Surgery. Read on as we discuss a concise guide to the fundoplication procedure for antireflux surgery.


As mentioned before, GERD is caused by the malfunctioning of the esophageal sphincter, resulting in the backward flow of stomach fluids (acid & bile), which ultimately damages the lining of the esophagus. Nissen fundoplication helps in fortifying the esophageal sphincter to prevent this backward flow. This procedure has a high success rate in the long term (provided the postoperative protocols are followed diligently). When considering undergoing antireflux surgery in Dallas, our team of surgeons is always ready to discuss your case in depth to chart the best way forward.

Eligibility Criteria

Surgical procedures are generally the last option for most diseases and medical conditions, and GERD is no exception. Patients who have tried non-surgical measures such as consuming antacids and losing weight through exercises & taking smaller meals, and still have heartburn issues, are recommended for antireflux surgery. The doctor can also disqualify you if you have or are taking certain medicines that contribute to GERD, such as insulin for diabetes or have a medical condition that may worsen due to antireflux surgery, such as morbid gastroparesis. When considering undergoing antireflux surgery in Dallas or Fort Worth, consult our team of bariatric doctors for a comprehensive screening evaluation to determine whether you qualify for the fundoplication procedure.

Variations in Techniques for Fundoplication

Depending on the extent of modifications required to strengthen the area around the esophageal sphincter, following are the variations in fundoplication techniques, all of which are performed laparoscopically:

  • Toupet 270-degree posterior wrap: In this technique, the fundus portion of the stomach is wrapped 270-degree around the posterior area of the esophagus, creating a valve-like structure to facilitate puking or burping.
  • Watson anterior 180-degree wrap: In this technique, the esophageal portion next to the diaphragm is reformed by wrapping the fundus halfway and then attaching it to the diaphragm tissue.
  • Nissen 360-degree wrap: As the name suggests, this technique is characterized by a complete wrap of the fundus portion of the stomach around the esophagus, restricting the space for vomiting or burping, which may worsen the condition.

Working Mechanism

Nissen fundoplication works on the principle of strengthening the esophageal sphincter to prevent the backward flow that causes heartburn. This is initiated by providing anesthesia to the patient, followed by making several small cuts through the skin and peritoneum, a tissue layer around the gut. Next, a thin, cylindrical, and lighted tube carrying a mounted camera is inserted through the cuts. Surgeons carefully wrap the fundus portion of the stomach around the esophagus, depending on the patient’s condition, and attach the two with dissolvable stitches. Surgeons make sure to vent out any remaining gas in the abdomen and retract all the tools carefully. Finally, dissolvable stitches are used to close external cuts. The steps involved in the Nissen fundoplication procedure vary depending on the variations in the technique.

Final Word

Nissen fundoplication is a minimally invasive and effective bariatric procedure to treat GERD. It requires the utmost precision when maneuvering tools to wrap the fundus. This calls for an experienced bariatric doctor that leverages years of expertise to help patients get relief from GERD. When considering reflux surgery in Dallas, look no further than DFW Bariatrics and General Surgery. Our team of highly skilled and experienced doctors provides 360-degree bariatric solutions and will assess your condition to chart the best way forward. To discuss your requirements or book an appointment, call 469-620-0222 or email us at [email protected]. Alternatively, you can fill out our contact form, and we’ll get in touch with you at the earliest.