One hundred consecutive laparoscopic Nissen's without the use of a bougie

Victor Bochkarev, Atif Iqbal, Yong Kwon Lee, Michelle Vitamvas, Dmitry Oleynikov

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: The creation of a floppy and symmetric fundoplication over a bougie has been the standard of care in laparoscopic surgery. The use of a bougie carries a risk of esophageal perforation but lowers the risk of postoperative dysphagia. Intraoperative esophagogastroduodenoscopy (IEGD) can be used to assess the orientation and position of a properly constructed Nissen. The aim of this study was to determine if IEGD can replace the routine use of a bougie in the creation of a fundoplication. Methods: One hundred consecutive patients undergoing laparoscopic Nissen fundoplication from 2003 to 2005 were entered into a prospective database. IEGD was used in all patients instead of a bougie. Preoperative and postoperative data, including symptom scores, pH studies, manometry, and upper gastrointestinal studies, were analyzed. Results: All 100 patients completed the study for a mean follow-up period of 18 months. The mean surgical time was 102 minutes. The mean intraoperative endoscopy time was 14 minutes. There were a total of 24 (24%) alterations of the fundoplication performed according to endoscopic wrap creation. The most common alteration was removal of a fundoplication stitch in 15 patients with a tight appearance of wrap. There were no major complications. Two patients required esophageal dilatation for mild to moderate dysphagia. Conclusions: IEGD is a valuable tool for laparoscopic Nissen fundoplication. IEGD helps to appreciate the true location of the gastroesophageal junction and allows for fundoplication adjustment based on additional visualization. The creation of a symmetric and floppy wrap during Nissen fundoplication can be facilitated greatly by intraoperative endoscopy and may lead to improved clinical outcomes without the risk of esophageal perforation.

Original languageEnglish (US)
Pages (from-to)866-871
Number of pages6
JournalAmerican journal of surgery
Issue number6
StatePublished - Dec 2007


  • Intraoperative endoscopy
  • Laparoscopy
  • Nissen fundoplication

ASJC Scopus subject areas

  • Surgery


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