Laparoscopic posterior 180° fundoplication for major dysphagia after Nissen procedure

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Laparoscopic   posterior   180°   fundoplication   for   major   dysphagia   after   Nissen   procedure

Authors
B Dallemagne
Keywords
RGO,Nissen,short esophagus,extensive dissection,mesh on the crura
Media type
Duration
19'00''
Publication
2005-11
Popular
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Audio
en
Subtitles
en
E-publication
WeBSurg.com, Nov 2005;5(11).
URL: http://www.websurg.com/doi-vd01en1870.htm

Laparoscopic   posterior   180°   fundoplication   for   major   dysphagia   after   Nissen   procedure

5. Gastric dissection 07'54''
So it’s a gastric valve. The other problem is that we try to understand exactly where the junction is. When you divided the stomach at the beginning, it didn’t look like an adhesion but more than that. Well, it was probably a wrap around the stomach. The 1st sutures are way down here. What we can do now is to mobilize the gastric fundus. Because apparently there is no problem around the crura repair. The esophagus is free. I think that the valve was too low because that creates a sort of fundoplication there below the GE junction. That’s one of the mechanisms that can explain the dysphagia. My strategy is to mobilize the gastric fundus in order to get a clear view on the shape of the gastric fundus. And afterwards, we’ll see if we create a sort of posterior mechanism. This case shows you what happens if you don’t do properly. That’s an operation that leads to a certain number of abuse I believe. Probably it creates a gastric pouch there, dividing the stomach in 2 parts. If you look at the X-rays, you can see this gastric pouch with bubbles or air inside. So I think it’s probably part of the mechanism. It’s what we call a bilobed stomach. I will mobilize the short gastrics to get a good view of the shape of the gastric fundus, and then probably I’ll redo a little partial posterior fundoplication. I think that we’ve almost finished the dismantling of the valve on the gastric fundus, and probably I think that we’ll do a posterior repair fundoplication.