Reoperative Laparoscopic Anti-Reflux Surgery

Contributors: Marco P. Fisichella

65 year old man who underwent a laparoscopic Nissen fundoplication in August 2015. Preoperative manometry was normal and DeMeester score was 25. Two months later he began to experience difficulty of swallowing solid foods, then liquids. After 2 dilatations, dysphagia persisted.

DOI#: http://dx.doi.org/10.17797/egw2097cpq

Referred By: Jeffrey B. Matthews

Laparoscopic Nissen Fundoplication

A 51-year-old man seeks medical attention for intermittent chest pain. He describes the pain as “burning” and it has become increasingly frequent after meals over the last 4 to 6 months. In addition, he experiences regurgitation, and often wakes up at night with a feeling of choking. He has also noted hoarseness and cough. Proton pump inhibitors are very helpful for the heartburn and chest pain but do not improve the regurgitation. Long-term results have shown that a fundoplication provides control of reflux in about 90% of patients. To achieve these results the surgeon should focus on the technical elements of the operation, rather than on the eponyms. The technical elements of the operation are the following: (1) division of the short gastric vessels to achieve complete fundic mobilization; (2) extensive dissection of the distal esophagus in the posterior mediastinum to bring the gastroesophageal junction at least 3 cm below the diaphragm; (3) meticulous closure of the right and left pillar of the crus with non-absorbable sutures; (4) use of a bougie to decrease postoperative dysphagia; (5) a short fundoplication with three interrupted stitches placed at 1 cm of distance from each other (2-2.5 cm long). All these technical elements have been shown to positively impact long-term outcomes. Patients who are still symptomatic postoperatively must be thoroughly evaluated to identify the cause of failure, and treatment must be individualized.

by
Ciro Andolfi (The University of Chicago Medicine)
Marco G. Patti (The University of Chicago Medicine)

DOI: http://dx.doi.org/10.17797/287pfs38ls

Editor Recruited By: Jeffrey Matthews, MD

Laparoscopic Extracorporeal Repair of a Morgagni Diaphragmatic Hernia

Contributors: Anahita Jalilvand  and Marco P. Fisichella

This video describes a laparoscopic-extracorporeal repair with mesh of a Morgagni diaphragmatic hernia in an 81 year old female.

We used Ventralight™ ST Mesh which is an uncoated lightweight monofilament polypropylene mesh on the anterior side with an absorbable hydrogel barrier based on Sepra® Technology on the posterior side for laparoscopic ventral hernia repair. The posterior side mesh does not cause adhesion with the abdominal organs.

DOI: https://doi.org/10.17797/k8ktfjncgn

A quick review of the literature of laparoscopic cases has shown that in a substantial amount of cases the hernia was reduced and the defect repaired with mesh placement without hernia sac resection . Therefore, non-resecting the sac is an acceptable option.

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