Modified Nissen fundoplication in the treatment of gastroesophageal reflux disease.

Twenty-five consecutive patients underwent a primary modified Nissen fundoplication for gastroesophageal reflux disease. According to this procedure, an increase of the diameter of the gastric wrap to a comfortable passage of the surgeon's index finger between oesophagus and gastric 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 gastroesophageal junction strengthened by four mesh pledgets. Two more stitches between the seromuscular layer of the gastric fundus and the oesophageal musculature were placed to prevent reduction of created oesophagogastric intussusception. The results of this modified Nissen procedure are excellent during the early postoperative follow-up period, ranging from 10 to 45 months and averaging 26 months.