Laparoscopic and Open Nissen Fundoplication

• Evidence of gastroesophageal reflux disease (GERD) plus:
  
  
  
  • Sequelae of GERD refractory to medical therapy (eg, esophageal strictures, Barrett’s esophagus, recurrent aspiration, or pneumonia).
    
  • Persistent reflux symptoms despite maximal medical therapy.
    
  • Paraesophageal hernia.

Laparoscopic and Open Paraesophageal Hernia Repair

• Objective evidence of paraesophageal herniation.
  
• Many patients are asymptomatic and a large number of cases are found incidentally.

Absolute

• Inability to tolerate general anesthesia.
  
• Uncorrectable coagulopathy.