Figure 2

Construction of the Nissen fundoplication. A number 60-French bougie is passed across the gastroesophageal junction. Seromuscular heavy nonabsorbable sutures are used to approximate the adjacent layers of gstric fundus and incorporating the anterior wall of the esophagus. Pledgets at each tissue interface, buttressed with a horizontal mattress suture, hold the wrap. Interrupted sutures can also be used for the construction.