If I'm not mistaken, the fundus of the stomach can be wrapped around the lower portion of the esophagus in varying 'degrees' to provide a tightening effect. If it were wrapped at 360 degrees, it would go completely around. 180 degrees would be less, etc.
Close but no cigar. All Nissen fundoplications are 360 degree wraps. There are other versions of fundoplications such as the Toupet which is a 270degree wrap. In the 1950's, Nissen fundoplications were done fairly tightly. This means that the portion that was wrapped around the esophagogastric junction was literally snug. This resulted in two bad things. First, the tightness produced trouble swallowing because it was too tight. Second, it worked too well in preventing reflux. People could not burp or vomit when they needed to. They also were miserable from bloating because of the air that they swallowed. A guy by the name of DeMeester performed a huge number of these operations varying several parameters. One method of controlling the tightness was to pass a dilator down the esophagus when the wrap was performed. He also changed the length of the wrap. As it turns out, a very loose, or what we have come to term "floppy" wrap is quite effective at preventing reflux but has a very low incidence of either swallowing trouble or gas-bloat syndrome. By the time these were being done laparoscopically the floppy Nissen had become the accepted standard for an anti-reflux procedure. Although at least six other operations were being done for reflux 80% were Nissens. Today, it is rare that anyone gets an operation other than a Nissen or a Toupet.
be careful with getting them types of surgery because them wraps have a tendency to drop down and close off the stomach opening and the food has a hard time going down then the esphogus then gets stretched and if they redo it and stitch it on dead tissue it wont hold because it wont heal and can come apart because when they do the initial surgery they cut off blood cirrulation and the stomach tissues then dies
Extremely rare set of complications. In most series between one and two percent will require revision surgery. A "slipped" wrap is possible but usually pretty straightforward to correct. I don't understand the vascular compromise. This would be very odd.
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