We try to prevent this problem by constructing the wrap while there is a large tube inside the esophagus, hopefully preventing the surgeon from making the wrap too tight. This operation is commonly called the Nissen Fundoplication , named after Rudolf Nissen. There are several variations of the operation which try to prevent problems with the wrap being too tight. Instead of wrapping the fundus of the stomach all the way around the esophagus as in the Nissen procedure, it is possible to only wrap the stomach part way around the esophagus, suturing the wrap to the esophagus itself rather than the stomach on the other side of the wrap. This modification is called the Toupet Fundoplication.
Some surgeons choose to perform the operation through the chest.
This involves going into the chest and bringing the stomach up from the abdomen into the chest, where the fundoplication is performed. The stomach is then returned to the abdominal cavity and the diaphragm is then repaired. This operation is called the Belsey Mark IV procedure. In the Belsey procedure, the stomach is also wrapped only partially around the esophagus. The Belsey procedure can also be done by minimally invasive techniques.