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Redo Nissen fundoplication with stapled-wedge Collis gastroplasty

This video demonstrates a redo laparoscopic Collis-Nissen gastroplasty in a patient with recurrent gastroesophageal reflux symptoms and short esophagus. The first step of this redo procedure consists in taking down the previous fundoplication in order to identify the mechanism underlying the failure of the initial repair. The surgeon demonstrates an extensive mobilization of the esophagus through the hiatus to achieve adequate length of intra-abdominal esophagus. Despite this, the esophagus was too short and the surgeon performs a Collis gastroplasty using the wedge gastrectomy technique over a 50 French bougie. A 2.5 cm of tension-free intra-abdominal esophagus is achieved. The hiatus is repaired with interrupted non-absorbable sutures. A standard Nissen fundoplication is performed.

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Redo   Nissen   fundoplication   with   stapled-wedge   Collis   gastroplasty

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摘要
This video demonstrates a redo laparoscopic Collis-Nissen gastroplasty in a patient with recurrent gastroesophageal reflux symptoms and short esophagus. The first step of this redo procedure consists in taking down the previous fundoplication in order to identify the mechanism underlying the failure of the initial repair. The surgeon demonstrates an extensive mobilization of the esophagus through the hiatus to achieve adequate length of intra-abdominal esophagus. Despite this, the esophagus was too short and the surgeon performs a Collis gastroplasty using the wedge gastrectomy technique over a 50 French bougie. A 2.5 cm of tension-free intra-abdominal esophagus is achieved. The hiatus is repaired with interrupted non-absorbable sutures. A standard Nissen fundoplication is performed.
分類
complex cases
關鍵字
媒體類型
期間
11'00''
刊物
2006-11
普通的
最愛
Favorites Media
音訊
en
副標題
en
數位出版
WeBSurg.com, Nov 2006;6(11).
URL: http://www.websurg.com/doi-vd01en2029.htm

Redo   Nissen   fundoplication   with   stapled-wedge   Collis   gastroplasty

5. Freeing of esophagus 02'55''
Once the dissection is completed, it is easy to understand the mechanism underlying the recurrence of GERD symptoms in this patient and the development of dysphagia. The upper portion of the stomach has herniated through the fundoplication. The next operative step consists in undoing the previous 360° wrap. The different cleavage planes are found and dissection is facilitated by the identification of the old sutures. The wrap is opened and the two sides, the right and the left of the fundoplication, are freed from the esophagus. The right side of the fundoplication is dissected and once again the sutures placed during the first operation help to follow the correct planes. The right part of the fundoplication is then dissected along the right margin and posterior surface of the esophagus. At this level, dissection must be done carefully to avoid any injury to the vagus. Dissection should be performed in close contact with the fold of the fundoplication. Adhesions, due to the retro-esophageal position of the stomach, should also be freed. The aim of this wide dissection is to reconstruct the original anatomy of the stomach by undoing the first fundoplication wrap totally. Once this has been performed, the cardio-esophageal junction is identified. Given the mechanism of recurrence which evocates the suspicion of a short esophagus, the esophagus is further mobilised by intra-mediastinal dissection. An intraoperative endoscopy is performed as an additional test which helps to confirm that the gastroesophageal junction cannot be maintained within the abdominal cavity without tension. The pre-cardial fat is dissected in order to clearly identify the GE junction. Given the short esophagus, decision is made to perform an endoscopic Collis gastroplasty to lengthen the esophagus and allow a tension-free fundoplication.