General anesthesia is used to render the patient unconscious. Once the anesthesia has taken effect, the upper abdomen is cleaned with an antiseptic solution to lessen the risk for infection. In open surgery of Nissen fundoplication, the surgeon makes a 6- to 10-inch incision in the middle of the abdomen, from just below the ribs to the umbilicus (belly button). If the patient has a hiatal hernia, that is repaired first. The esophageal hiatus is tightened with a couple of stitches to prevent herniation of the fundoplication and then the surgeon performs the procedure of Nissen fundoplication. The upper portion of the stomach (the fundus), which is on the left side of the esophagus, is pulled behind and wrapped around the lower portion of the esophagus and then sutured to the portion of the stomach that has moved into the fundus's original position. This creates a "valve" that acts like the LES to prevent stomach acid from refluxing into the esophagus.
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