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Figure 7a: Normal laparoscopic Nissen fundoplication. (a) Semiprone (right anterior oblique) esophagram during distended single-contrast phase shows that fundoplication (arrows) primarily surrounds the distal esophagus (arrowhead). (b) Spot radiograph of gastric fundus with patient in right lateral 45° erect position shows the leaves of fundoplication (arrows) surrounding distal esophagus and small portion of the stomach (arrowhead). Even appropriately placed fundoplications include small portion of the stomach. This case shows that in normal fundoplication, it is often difficult to completely fill these leaves of the wrap with barium and air.
