Fundoplication, laparoscopic according to Toupet

A small skin incision is made well above the navel in the midline. After inserting the Veress needle and verifying the correct position, the pneumoperitoneum is established.

The optics are introduced via a 5mm/10mm trocar. A diagnostic laparoscopy is performed. Under direct vision, 4 trocars are placed in the upper abdomen.

The left liver lobe is held up with the laparoscopic probe and the stomach is tensed with the Babcock clamp. In the area of the pars flaccida, the lesser omentum is incised with the ultrasonic scalpel.

Now the right diaphragmatic crus is displayed. Then, proceed anteriorly over the anterior commissure to the left diaphragmatic crus and display it as well. In doing so, the ventral mediastinum is opened.

One now proceeds far into the lower mediastinum and circumferentially mobilizes the lower esophagus from its adhesions. In doing so, the posterior vagus nerve is clearly identified and remains with the esophageal musculature. The esophagus is mobilized from the mediastinum to the extent that the area of the lower esophageal sphincter is tension-free in the abdominal cavity.

The gastrosplenic ligament and the short gastric vessels are transected at the level of the splenic hilum along the greater curvature up to the upper pole of the spleen and further to the left diaphragmatic crus until the gastric fundus is completely mobilized.