Nissen Fundoplication is typically performed laproscopically. In some cases though, the doctor may need to make a larger incision or switch from laproscopic to the larger incision depending on what they find when they get in there.
If you have a hernia, the surgeon will "fix" it first. The surgeon then takes the top portion of the stomach, the fundus, and pulls it in behind the esophagus. It is then wrapped around the esophagus and stitched into place. Typicall this is done through 4-5 small incisions. I had 6 incisions during my procedure. They were all "sealed" up with steri-strips. No external stitches.
When completed, the stomach will contract around the esophagus every time it contracts normally. This keep the reflux from being able to come up into the esophagus. It also has the side effect of limiting the ability to vomit.
