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Related Experiment Videos

Geometry and reproducibility in 360 degrees fundoplication.

P R Reardon1, B D Matthews, T K Scarborough

  • 1Department of Surgery, Baylor College of Medicine, 6550 Fannin, Houston, TX 77030, USA.

Surgical Endoscopy
|August 24, 2000
PubMed
Summary

This study defines precise points for creating a reproducible, floppy 360-degree fundoplication (FP). The technique ensures accurate orientation and avoids twisting the fundus, simplifying surgical training.

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Area of Science:

  • Gastroenterology
  • Surgical Technique
  • Anatomy

Background:

  • Accurate anatomical landmarks are crucial for reproducible surgical outcomes.
  • Defining specific points on the anterior and posterior fundic walls is key for fundoplication (FP).
  • A loose or "floppy" 360-degree FP aims for optimal gastroesophageal function.

Purpose of the Study:

  • To precisely define two symmetrical points (a and b) for creating a reliable, reproducible, floppy 360-degree fundoplication (FP).
  • To establish a standardized method for fundoplication that ensures correct orientation and avoids twisting.

Main Methods:

  • Measurements were taken in cadavers (n=5) and intraoperatively (n=16) using a 60-Fr bougie.
  • Esophageal circumference (c) at the gastroesophageal junction (GEJ) was measured; diameter (d) was calculated.

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  • Specific lateral measurements from the GEJ and short gastric vessels defined points a and b.

    • Main Results:

    • Esophageal diameter ranged from 2.39 cm to 3.18 cm (mean 2.66 cm).
    • The defined points created an internal FP diameter of 3.82 cm, which is larger than the external esophageal diameter.
    • The technique resulted in a correctly oriented, symmetrical, floppy fundoplication, easily taught and reproducible.

    Conclusions:

    • Symmetrically placed points (a and b), 6.0 cm from the GEJ, can be used to create a floppy 360-degree fundoplication.
    • Suturing these points to the right of the anterior vagus nerve ensures reliable and reproducible results.
    • This method simplifies the creation of a true, floppy fundoplication, avoiding common technical pitfalls.