Perioperative management - Laparoscopic Toupet fundoplication - general and visceral surgery
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Indications
- Refractory GERD
- GERD not completely controlled by medication
- Patient desire against lifelong proton pump inhibitors
- Upside-down stomach
Contraindications
- No specific contraindications, if surgery is clearly indicated
Preoperative diagnostic work-up
- Gastroscopy
- Precise patient history
Optional:
- pH-metering
- Manometry
- Gastric films
Special preparation
- Enema on the eve of surgery
Informed consent
- General risks of surgery
- Postoperative dysphagia
- More air remaining in the alimentary tract
- Injury to the spleen
- Injury to the esophagus / stomach
- Denervation syndrome / diarrhea
- Pneumothorax
- Possible recurrence
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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