In GERD, it is usually performed when medical therapy has failed; but, with a Type II (paraesophageal) hiatus hernia, it is the first-line procedure.

[1] Dr. Rudolph Nissen (1896–1981) first performed the procedure in 1955 and published the results of two cases in a 1956 Swiss Medical Weekly.

[6] Complications that arise from long term GERD such as severe esophagitis, stricture formation, and ulcer development, all of which can be seen on endoscopy, warrant surgical intervention.

[7] In the pediatric population, infants who fail to thrive or have inadequate weight gain despite proton-pump inhibitor (PPI) therapy may also benefit from fundoplication.

[10] When used to alleviate gastroesophageal reflux symptoms in patients with delayed gastric emptying, it is frequently combined with modification of the pylorus via pyloromyotomy or pyloroplasty.

[12] Fundoplication was found to be better at increasing LES pressure than PPI therapy, whilst having similar risk for adverse events.

If the symptoms warrant a repeat surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.

[19] Dysphagia that persists longer than 3 months will need further evaluation, typically with a barium swallow study, esophageal manometry, or endoscopy.

[18] Depending on the etiology of persistent dysphagia, a trial of PPI therapy, endoscopic dilation, or surgical revision may be necessary.

[21] Vomiting is sometimes impossible or, if not, very painful after a fundoplication, with the likelihood of this complication typically decreasing in the months after surgery.