Nissen Fundoplication Technique Research Articles

Comparison of Early Outcomes of Laparoscopic Floppy Nissen Fundoplication and Laparoscopic Toupet Fundoplication in the Treatment of Type III and IV Hiatal Hernia

Objective: This study aims to compare the laparoscopic Floppy Nissen fundoplication technique (LFNFT) and the laparoscopic Toupet fundoplication technique (LTFT) used in treating Type III and IV hiatal hernias (HHs).
 Materials and Methods: This retrospective analysis was conducted after ethical approval. Patients who underwent Type III and IV hiatal hernia surgery were searched between January 2020 and May 2022. Patients who underwent LFNFT and LTFT for hiatal hernia repair were selected. Patients under 18 and patients who were followed up in our clinic after surgery were excluded from the study. The clinical and follow-up differences between the groups were evaluated statistically.
 Results: Of the 38 patients who met the study criteria, 27 (71.1%) were female. The mean age of all patients was 41.39±14.03 years (21-77). 10 (26.3%) patients had Type 3 HH, and the remaining patients (73.7%) had Type 4 HH. LFNFT was performed on 27 (71.1%) patients, and LTFT on 11 (28.9%). Complications developed in 14 (36.8%) patients in the postoperative follow-up, and the most common difficulty was gas bloating, with a rate of 13.1%. In comparing the groups, LTFT was preferred in the male patients (p=0.005) and younger patients (p

A retrospective study on the evaluation of the symptoms, medications and improvement of the quality of life of patients undergoing robotic surgery for gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder requiring lifestyle adaptations and administration of medications. Another approach is the surgical treatment of GERD through laparoscopic or robotic operations. The aim of the present study was to investigate the improvement of symptoms and quality of life of patients with GERD, before and after robotic surgical restoration using the Nissen robotic fundoplication technique. The potential effects of body weight, age and sex, as well as the response to medications and progress over time, were also assessed. A retrospective study was conducted in a tertiary hospital between October 2019 and March 2020. Data were collected and recorded from 144 patients who underwent robotic surgery, using the Nissen fundoplication technique, during the period 2009-2019. All patients involved in this analysis pre-operatively exhibited severe symptoms of heartburn and reflux, as well as poor quality of life. All of these symptoms were re-examined after surgery, and a marked decrease was observed with respect to their frequency and intensity. Improvement was not affected by body mass index, whereas older patients exhibited greater improvement. Women initially experienced more severe symptoms before the surgery, but they appeared to respond as well as the male patients. The long-term beneficial effects of surgery for up to the 10-year period studied were validated. After the robotic surgical rehabilitation, the vast majority of patients overcame the unpleasant symptoms of GERD and stayed off their medications. More than 4/5 of the patients were satisfied after surgery. In conclusion, restoration of GERD, using Nissen robotic fundoplication, led to the minimization of symptoms and to a marked improvement in the quality of life of patients.

PLATYPNEA-ORTHODEOXIA SYNDROME AFTER NISSEN FUNDOPLICATION

Platypnea-Orthodeoxia syndrome as a complication of Nissen fundoplication can be a challenging case to diagnosis due to rarity of the presentation. A 78-year-old female underwent hiatal hernia repair surgery via laparoscopy using Nissen Fundoplication technique. Her postoperative course was

The rabbit as a surgical model for early training stages of the laparoscopic Nissen fundoplication technique

This study describes the advantages and disadvantages of using the rabbit as an animal model for surgical training in the Nissen laparoscopic fundoplication technique. Six New Zealand rabbits weighing between 2.5 and 3.5 kg were used. Nissen fundoplication was performed successfully in five out of six animals. Average procedure time was 47 minutes, with a maximum of 80 minutes for the first surgery and a minimum of 30 minutes for the last. Main advantages of the rabbit model are ease of animal restrain and low cost. The rabbit allows for the recreation of the human surgical environment, albeit showing a lower degree of difficulty. We thus consider this surgical model to be valuable only for skill development on basic stages of the laparoscopic Nissen fundoplication technique. For advanced stages of this surgical procedure, use of other animal models with further anatomical similarities to humans, such as the swine model, are recommended.

Validation of a Model of Intensive Training in Digestive Laparoscopic Surgery

IntroductionOur objective was to assess a laparoscopic training model for general surgery residents. MethodsTwelve general surgery residents carried out a training programme, consisting of a theoretical session (one hour) and a hands-on session on simulator (7h) and on animal model (13h). For the first and last repetitions of simulator tasks and the Nissen fundoplication technique, time and scores from the global rating scale objective structured assessment of technical skills (OSATS) were registered. Before and after the course, participants performed 4 tasks on the virtual reality simulator LAPMentor™: (1) hand–eye coordination, (2) hand–hand coordination, (3) transference of objects and (4) cholecystectomy task, registering time and movement metrics. Moreover, the residents completed a questionnaire related to the training components on a 5-point rating scale. ResultsThe last repetition of the tasks and the Nissen fundoplication technique were performed faster and with a higher OSATS score. After the course, the participants performed all LAPMentor™ tasks faster, increasing the speed of movements in all tasks. Number of movements decreased in tasks 2, 3 and 4; as well as path length in tasks 2 and 4. Training components were positively rated by residents, being the suture task the aspect best rated (4.90±0.32). ConclusionsThis training model in digestive laparoscopic surgery has demonstrated to be valid for the improvement of basic and advanced skills of general surgery residents. Intracorporeal suturing and the animal model were the best rated training elements.

Validación de un modelo de formación intensiva en cirugía digestiva laparoscópica

IntroductionOur objective was to assess a laparoscopic training model for general surgery residents. MethodsTwelve general surgery residents carried out a training program, consisting of a theoretical session (one hour) and a hands-on session on simulator (7 h) and on animal model (13 h). For the first and last repetitions of simulator tasks and the Nissen fundoplication technique, time and scores from the global rating scale objective structured assessment of technical skills (OSATS) were registered. Before and after the course, participants performed 4 tasks on the virtual reality simulator LAPMentor™: 1) hand-eye coordination, 2) hand-hand coordination, 3) transference of objects and 4) cholecystectomy task, registering time and movement metrics. Moreover, the residents completed a questionnaire related to the training components on a 5-point rating scale. ResultsThe last repetition of the tasks and the Nissen fundoplication technique were performed faster and with a higher OSATS score. After the course, the participants performed all LAPMentor™ tasks faster, increasing the speed of movements in all tasks. Number of movements decreased in tasks 2, 3 and 4; as well as path length in tasks 2 and 4. Training components were positively rated by residents, being the suture task the aspect best rated (4.90±0.32). ConclusionsThis training model in digestive laparoscopic surgery has demonstrated to be valid for the improvement of basic and advanced skills of general surgery residents. Intracorporeal suturing and the animal model were the best rated training elements.

Left Side First Approach in Nissen Procedure for Gastroesophageal Reflux Disease; How We Do It

Introduction Gastroesophageal reflux disease (GERD) is a major public health problem. The gold standard in the surgical treatment of this condition is the laparoscopic technique called Nissen fundoplication. Aim This paper presents a safer alternative of the laparoscopic Nissen fundoplication, with special focus on the most difficult moment of the intervention, the creation of a retroesophageal passage. Material and method (presentation of the surgical technique) The conventional Nissen technique consists of the dissection of the esogastric junction in a clockwise direction, right to left: right pillar, hiatus, left pillar, retroesophageal passage, skeletonization of the fornix and reconstruction of the valve. We decided to perform a technique inspired from laparoscopic sleeve gastrectomy, which starts in anti-clockwise direction, with the skeletonization of the upper third of the greater curvature of the stomach, then continues with the complete dissection of the left diaphragmatic pillar (left side first) and finally with the dissection of the right pillar and the creation of the retroesophageal passage, thus, the procedure becoming less complicated. A complete decollement of the area nuda is performed, this way avoiding possible complications at this stage, like: bleeding from the area nuda or short vessels, ruptures of the stomach, esophagus, spleen, penetrating the thoracic cavity with a retroesophageal clamp, etc. Results Introduced in 2011, this technique was applied with success in all 20 consecutive cases of hiatus hernia operated in our clinic. There were neither intraoperative accidents and conversions nor early or late postoperative complications. 19 cases were primary Nissen while one case was a recurrent hiatal hernia after an insufficient cruroplasty made in another center. There were three cases in which we had to use Parietene Composite type mesh to strengthen the cruroplasty. Conclusion The applied modification has improved the original laparoscopic Nissen fundoplication technique,

Laparoscopic Nissen repair: indications, techniques and long-term benefits.

The Nissen fundoplication or total 360 degrees fundoplication is probably the most frequently used anti-reflux procedure throughout the world. With the advent of laparoscopic surgery the popularity among surgeons to perform a laparoscopic Nissen fundoplication has even increased. The purpose of this paper is to provide an overview of the experience of laparoscopic Nissen fundoplication over the past 15 years. We performed an extensive review of the literature in order to ascertain the representative papers. In addition, available consensus papers, especially with regard to indication and technique, were assessed. Indication for a laparoscopic Nissen fundoplication should depend on documentation of the presence of disease as well as objective testing of the functional disorders and the complications. The technique of Nissen fundoplication is discussed controversially. Consensus exists with regard to floppiness of the wrap, necessary closure of the crurae and the use of a calibration method during the performance of the wrap. The laparoscopic technique creates a learning curve, which needs to be respected. Large prospective series in recent years have shown a complication rate between 5% and 10%, depending on the definition of the complication. In these last prospective series good and excellent results have been reported, of between 85% and 95%. Reflux recurrence is reported as between 1% and 8.5%, with a concomitant dysphagia rate of 0%-10%. The Nissen fundoplication is currently performed throughout the world, most frequently in a minimally invasive technique. Several randomized trials that have been performed in the past years document that the Nissen fundoplication is an effective procedure for the treatment of pathological gastro-oesophageal reflux disease when a critical indication is used for well-defined patients.

Laparoscopic fundoplication and gastrostomy.

Minimally invasive surgical approaches to various pediatric surgical disease processes are becoming the standard of care. Laparoscopic Nissen fundoplication is transitioning toward the preferred method for the surgical correction of gastroesophageal reflux (GER) disease in infants and children that do not respond to medical management or have complications from their GER. This approach offers a shorter hospitalization, reduced discomfort, and cosmetic advantages when compared with the open operation. This report discusses the pathophysiology of GER, its clinical manifestations, and the diagnostic evaluation for this disorder. Also, the laparoscopic Nissen fundoplication technique currently utilized at Children's Mercy Hospital is described.

Hiatal hernia controversies--a review of pathophysiology and treatment options.

To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments. Review article. Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment. Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present. Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or 'floppy' Nissen fundoplication in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.

Hiatal hernia controversies ‐ a review of pathophysiology and treatment options

Objective To provide a detailed discussion of the aetiology and pathophysiology of hiatal hernia in both humans and small animals, and review current medical and surgical treatments. Design Review article. Summary Hiatal hernia is not completely understood in humans or animals. It has a complex multifactorial aetiology and pathophysiology. A primary disturbance of the lower oesophageal sphincter has not been shown in humans or animals. Knowledge of pathophysiology is necessary to institute appropriate treatment.Medical and/or surgical therapy is not indicated in asymptomatic cases. Medical treatment should be used for up to 1 month in stable cases of sliding hiatal hernia. Paraoesophageal hiatal hernias and any large sliding hiatal hernia should be considered for prompt surgical treatment. Surgical techniques used depend on the type of hiatal hernia present.Surgical treatment of hiatal hernia cases should be performed by experienced surgeons, and must include hiatal closure and gastropexy. The Nissen fundoplication procedure has been discontinued in the veterinary field due to poor success rates, coupled with the published view that there is a marked difference in pathophysiology between humans and dogs. Reported complications associated with the original Nissen fundoplication technique are identical in the human and veterinary literature. There have been no complications reported with use of the modified or ‘floppy’ Nissen fundoplica‐tion in dogs. Both oesophagopexy and Nissen fundoplication require further evaluation in small animals.