Nissen fundoplication as the surgical technique of choice in patients with hiatal hernia

Abstract

Introduction. Hiatal hernia is defined as a displacement of the abdominal structures towards the thorax through the esophageal hiatus. They are classified into four types according to the anatomical relationship between the stomach and the hiatus. Its prevalence is higher in women and the elderly, and it is often associated with obesity and genetic factors. They are usually asymptomatic, but patients may report gastroesophageal reflux, dyspnea, or chest pain, and are frequently detected incidentally. Upper digestive endoscopy is the main diagnostic method, complemented by X-rays, esophagograms, and CT scans. Treatment includes conservative management or surgery, with Nissen Fundoplication being one of the procedures of choice due to its efficacy assessed by the elimination of symptoms. Objective. To evaluate the effectiveness of Nissen fundoplication as the treatment of choice in patients diagnosed with hiatal hernia refractory to conservative treatment, analyzing its impact on the resolution of the clinical picture through a bibliographic review of updated scientific evidence. Methodology. A search was performed in scientific databases selecting articles based on reliability, validity, and clinical relevance, prioritizing publications in English and Spanish from the last 6 years, 14 articles with an elevated level of evidence that met the established criteria were chosen. Results. Hiatal hernia occurs when the cardia protrudes through the esophageal hiatus. Its diagnosis is usually incidental, with endoscopy and esophagogram standing out as the main tools. Conservative treatment with PPIs is the first-line therapy for type I hernias, reserving surgery for refractory or severe cases; Nissen fundoplication is the most used surgical procedure due to its high effectiveness, although there are other techniques such as Toupet or Dor, which reduce postoperative discomfort such as dysphagia, which implies a challenge when choosing the appropriate surgical technique for each patient. Conclusion. Hiatal hernia is a complex condition that requires timely diagnosis to determine the appropriate treatment. Management depends on the type of hiatal hernia and its severity. Thus, Type I hernias respond to conservative treatments with PPIs and lifestyle changes, while Type II-IV hernias usually require surgery. Nissen fundoplication, performed by laparoscopy, is the most effective surgical treatment, although it can cause dysphagia and abdominal distension, so it is important to assess conditions such as the length of the esophageal sphincter and BMI, highlighting the need to personalize treatment to optimize results and improve the patient's quality of life. General Area of Study: Medicine. Specific area of study: General surgery. Type of study: Bibliography Review.