Loose Floppy Nissen Fundoplication

A loose floppy Nissen fundoplication aims to control gastroesophageal reflux while preserving normal swallowing function. In this technique, a short, tension-free 360-degree wrap of the gastric fundus is created around the distal esophagus, ensuring that the fundoplication remains truly floppy rather than tight or rigid. Excessive tightness of the wrap can result in postoperative dysphagia, gas-bloat syndrome, and impaired ability to belch. Although many surgeons use a bougie to calibrate the wrap, some surgeons prefer to perform the fundoplication without a bougie. The concern is that the presence of a bougie may falsely reassure the surgeon and still lead to overtightening of the wrap once the bougie is removed. With meticulous dissection, adequate esophageal mobilization, and respect for tissue tension, a well-constructed floppy Nissen can be safely achieved without bougie guidance. This approach emphasizes surgical judgment and anatomical assessment to achieve effective reflux control with minimal functional complications.