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Laparoscopic Antireflux Procedures

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Lap Nissen-360
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w Esophageal Length.
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Laparoscopic Antireflux Procedures
Technique: Laparoscopic Nissen w Esophageal lengthening [Collis Type]
 

A short esophagus is the end result of severe, long-standing GE reflux. Fibrosis, stricture and Barrett's epithelium are frequently associated with this anatomical finding. Technically, the shortening of the esophagus does not allow the surgeon to perform a laparoscopic or an open Nissen Fundoplication without tension. Thus, the lower esophagus has to be lengthened prior to constructing the fundoplication.

Additional Instruments Needed:

1 - Premium Plus CEEA* 25 Disposable Stapling Instrument

1 - ENDO GIA* Universal

 

 

The anti-reflux procedure is initiated as described above. A large GE window is created. It now becomes essential to precisely locate the GE junction. The dissection of the lesser gastric curvature and of the posterior aspect of the stomach is extended downward so the entire upper portion of the stomach is mobilized posteriorly in order to make the stomach very mobile. The short gastric vessels are divided with the ULTRASHEARS* Instrument.

The lateral trocar site is enlarged to accommodate the insertion of a CEEA* 25 stapling device (without a trocar). The detached anvil is inserted and dropped into the intra-abdominal cavity. The CEEA* stapler is inserted (retracted trocar in place). The trocar is exposed. An ENDO BABCOCK* instruments and a non traumatic grasper are used to secure or maintain the stomach immobile so the trocar can be "poked" through both the anterior and posterior gastric walls. 

A Bougie # 54 or 60 in inserted in the esophagus into the stomach. The Bougie is used to guide the placement of the CEEA stapling device [right against it].

By rotating the CEEA*, the posterior wall and the trocar (through the anterior and posterior wall) is exposed. Using the ENDO BABCOCK* Instrument, the trocar is removed from the stapler and from the intra-abdominal cavity. The anvil is snapped, attached and the stapler closed. The operator should verify the gastric wall is not wrinkled between the jaws of the stapler. The stapler is fired leaving a 2.5 cm round, stapled window. The stapler is removed, the trocar site tightened with a facial suture and a 12 mm trocar inserted. An ENDO GIA* Instrument stapling device is inserted via the newly formed window and closed parallel to the lesser curvature.

 

The ENDO GIA* Instrument is fired in the direction shown [against the bougie] and withdrawn. It sometimes needs to be fired twice. The gastric tube of approximately 5 cm can be built or created to lengthen the lower esophagus in intra- abdominal position. The procedure is then completed by creating the Nissen Fundoplication around the gastric tube.

Proceed with the Standard Fundoplication Technique

 

Procedural Videos
> Lap Nissen: 360 Deg. Simple - Full

> Lap Nissen: 360  Deg. Complicated

> Lap Nissen: Using the EndoStich Instrument.

> Lap Nissen: Taking down the short gastric vessels with the UltraShears instruments

> Lap Nissen: Management of Iatrogenic Splenic Tear

> Lap Toupet: 270 Deg. Full

> Reinforced Lap Nissen: 360 Deg. Full

> Lap Nissen with closure of large Paraesophageal Hernia

> LapNissen with Esophageal Lengthening

> Lap Nissen: Revision of Failed Lap Nissen

> Lap Nissen: Revision of Open Nissen Fundoplication

> Lap Nissen with Hepatic Shoulder

 


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