Laparoscopic Toupet fundoplication

  1. Skin incision

    Video
    Skin incision

    One midline skin incision markedly superior to the umbilicus. After having introduced the Verres needle and checked its correct position, establish the pneumoperitoneum.

  2. Trocar positioning

    Video
    Trocar positioning

    Introduce the laparoscope with attached camera through a 5 mm/10 mm trocar. Perform a diagnostic laparoscopy. Introduce 4 epigastric trocars under direct visual control.

  3. Extending the stomach and incising the omentum

    Video
    Extending the stomach and incising the omentum

    Lift up the left hepatic lobe with the exploratory probe and tense the stomach with the Babcock clamp. Incise the flaccid portion of the lesser omentum with the harmonic scalpel.

  4. Exposing the diaphragmatic crura and entering the mediastinum

    Video
    Exposing the diaphragmatic crura and entering the mediastinum

    Now expose the right crus of the diaphragm. Via the anterior commissure then proceed anteriorly to the left crus and expose it as well. This opens up the mediastinum anteriorly.

  5. Mobilizing the gastric fundus

    Video

    At the level of the splenic hilum transect the gastrosplenic ligament and short gastric vessels along the greater curvature up to the superior pole of the spleen and further on to the left crus of the diaphragm, until the gastric fundus has been freed completely.

Exposing the lower esophagus

Now continue far into the inferior mediastinum and free the lower esophagus in circular fashion fro

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