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Related Experiment Videos

A simplified approach to laparoscopic fundoplication

G S Ferzli1, J B Hurwitz, A Hallak

  • 1Department of Laparoendoscopic Surgery, Staten Island University Hospital, 78 Cromwell Ave., Staten Island, NY 10304, USA.

Surgical Endoscopy
|May 1, 1997
PubMed
Summary
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Dividing short gastric vessels (SGV) in laparoscopic fundoplication for GERD is assessed. Novel techniques simplify decision-making, making the procedure effective for reflux symptom relief.

Area of Science:

  • Gastroenterology
  • Minimally Invasive Surgery
  • Surgical Techniques

Background:

  • Controversy exists regarding the division of short gastric vessels (SGV) during laparoscopic fundoplication for gastroesophageal reflux disease (GERD).
  • Identifying crural fibers for esophageal encirclement can be challenging in laparoscopic procedures.

Purpose of the Study:

  • To evaluate the necessity of dividing SGV during laparoscopic fundoplication.
  • To introduce techniques for improved intraoperative decision-making and procedural ease.

Main Methods:

  • Assessing the ease of apposing the gastric fundus to the anterior abdominal wall to determine SGV preservation.
  • Employing a posterior gastric approach when SGV division is necessary.
  • Using methylene blue injection to identify left crural fibers when dissection is difficult.

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Main Results:

  • Twenty laparoscopic fundoplications were performed for severe GERD (grade 3 esophagitis, high DeMeester score, low LES pressure).
  • Median operative time was 175 minutes with no conversions or mortality.
  • Postoperative outcomes included transient dysphagia (3 patients) and pneumonia (1 patient), with a median 3-day hospital stay.
  • All patients achieved symptom resolution at follow-up (7-42 months).

Conclusions:

  • The described intraoperative techniques facilitate decision-making in laparoscopic fundoplication.
  • These methods contribute to a simpler and more effective surgical approach for GERD treatment.