PS01.052: OUR STANDARD PROCEDURE IN LAPAROSCOPIC NISSEN FUNDOPLICATION FOR GERD PATIENTS

Abstract

Abstract Background Laparoscopic techniques in anti-reflux surgery for GERD patients are still considered complicated by many surgeons. We have established our simple procedure. Methods: SURGICAL PROCEDURE Setting Our 5-trocar setting with patients is as follows: 12 mm trocar just below the navel (A), 5 mm trocar at the upper right abdomen for pulling up lateral segment of the liver, 5 mm trocar at the upper right abdomen, 12 mm trocar at the upper left abdomen (B), 5 mm trocar at the middle left abdomen (C). Step 1 Under laparoscopic view, left part of the lesser omentum was cut with preserving the hepatic branch of vagus nerve. The right crus of the diaphragma has been dissected free from the soft tissue around the stomach. In this step the fascia of the right crus should be preserved and the soft tissue should not been damaged to avoid unnecessary bleeding. After cutting the peritoneum just inside the right crus, the soft tissue was dissected bluntly to left side. Then the inside margin of the left crus of the diaphragma was recognized from right side. In this part, laparoscope: trocar (A), the assistant: trocar (B), the operator's right hand: trocar (C). Step 2 The branches of left gastroepiploic vessels and the short gastric vessels were divided. The left crus of the diaphragma was exposed and the window at the posterior side of the abdominal esophagus was widely opened. In this part, laparoscope: trocar (A) at the beginning of dividing left gastroepiploic vessels, trocar (B) when dividing short gastric vessels. Step 3 The both crus are sutured with interrupted stitches to reduce the hiatus. From the right side, the fundus of the stomach is grasped through the widely opened window behind the abdominal esophagus. Then the fundus of the stomach is pulled to obtain a 360 degree ‘stomach-wrap’ around the abdominal esophagus. Using 2–0 non-absorbable braided suture, stitches are placed between both gastric flaps. Results We have performed this procedure in 90 cases. The mean operation time of recent 20 cases was 90 min. Conclusion We have established our standard anti-reflux surgery procedure with less bleeding and less operative time. Disclosure All authors have declared no conflicts of interest.