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Laparoscopic Toupet fundoplication - general and visceral surgery
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Extending the stomach and incising the omentum
Exposing the diaphragmatic crura and entering the mediastinum
Mobilizing the gastric fundus
Exposing the lower esophagus
Now continue far into the inferior mediastinum and free the lower esophagus in circular fashion from its adhesions. When doing so, the posterior vagus nerve must be positively identified and left clinging to the esophageal muscles. Free the esophagus from inside the mediastinum until the region of the lower esophageal sphincter rests inside the abdominal cavity without any tension.
Fixating the fundus cuff I
Clearly identify the anterior branch of the vagus nerve. With a running suture (non-absorbable braided suture size 2/0) first fixate the right ear of the fundus to the right side of the esophagus while sparing the anterior branch of the vagus nerve. Then fixate the right part of the fundus to the right crus of the diaphragm with another running suture (non-absorbable braided suture size 2/0).
Fixating the fundus cuff II
Fixating the left fundus
Closure and dressing