Nissen fundoplication - general and visceral surgery
You have not purchased a license - paywall is active: to the product selection
Access/trocar sites
After transverse incision at upper pole of the umbilicus establish pneumoperitoneum and then insert 10 mm laparoscope. Insert four 5 mm trocars under transillumination in a semicircle superior to the umbilicus, one each in the left and right medioclavicular and anterior axillary line. Work through both medial 5 mm trocars, while the left lateral trocar is used for the liver retractor and the right lateral trocar for a grasper holding the stomach. Anti-Trendelenburg position of the patient and OR Table tilted slightly to the left.
Incising the greater omentum and exposing the right crus of the diaphragm
Lifting up the left hepatic lobe with a liver retractor reveals the esophageal hiatus. Dissection with the harmonic scalpel begins by incising the lesser omentum at the pars flaccida while simultaneously pulling the stomach up to the left to the free margin of the right crus of the diaphragm. Now expose the gastroesophageal junction at the right crus while evading the posterior vagal trunk.
Exposing the left crus of the diaphragm
Mediastinal mobilization of the distal esophagus
Posterior hiatoplasty
Mesh augmentation of the esophageal hiatus
Mobilizing the gastric fundus
Nissen fundoplication
Leak testing, drainage
Single Access
Access to this lecture
for 3 days
€4.99 inclusive VAT

webop-Account Single
full access to all lectures
price per month
for the modul: vascular surgery