Laparoscopic Nissen fundoplication and gastrostomy for a giant hiatal hernia in an infant with situs inversus totalis

The article presents the results of a prospective controlled parallel clinical study of a new modification of laparoscopic antireflux surgery in the treatment of gastroesophageal reflux disease in combination with a hiatal hernia compared with laparoscopic Nissen fundoplication in terms of assessing quality of life after surgery. Clinical and instrumental examination of patients was carried out a year after surgical interventions. In accordance with the results of instrumental examination after surgery, the proposed modification of laparoscopic partial fundoplication is not inferior to laparoscopic Nissen fundoplication both, in terms of relief of reflux esophagitis symptoms and in relation to the recurrence of hiatal hernia. Clinical monitoring indicates a significantly higher quality of life for patients after the modified antireflux surgery, which is associated with a number of factors. The implementation of this fundoplication led to a decrease in the number of patients with complaints of dysphagia, the development of which is directly related to the surgery performance, as well as to a statistically significant reduction of bloating in the upper abdomen. Another advantage of the modified surgery is a significantly smaller number of cases of gas-bloat syndrome. In addition, the disorders developing in the framework of the gas bloat syndrome after laparoscopic Nissen fundoplication are more severe.

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Laparoscopic Nissen Fundoplication in an Infant with Situs Inversus

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2006.0244 ◽

2007 ◽

Vol 17 (5) ◽

pp. 698-700 ◽

Cited By ~ 2

Author(s):

Allan Tsung ◽

Alexander Feliz ◽

Timothy D. Kane

Keyword(s):

Situs Inversus ◽

Nissen Fundoplication ◽

Laparoscopic Nissen Fundoplication ◽

Laparoscopic Nissen

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633 CONVERSION TO TOUPET FUNDOPLICATION WITH DISTAL GASTRECTOMY AND ROUX-EN-Y GASTROJEJUNOSTOMY AFTER FAILED NISSEN FUNDOPLICATION

Diseases of the Esophagus ◽

10.1093/dote/doab052.633 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Italo Braghetto ◽

Owen Korn ◽

Manuel Figueroa ◽

Carlos Mandiola ◽

Ana Maria Burgos ◽

...

Keyword(s):

Hiatal Hernia ◽

Distal Gastrectomy ◽

Nissen Fundoplication ◽

Acid Reflux ◽

Laparoscopic Nissen Fundoplication ◽

Barium Swallow ◽

Toupet Fundoplication ◽

Laparoscopic Toupet Fundoplication ◽

Reflux Symptoms ◽

Laparoscopic Nissen

Abstract Laparoscopic Nissen Fundoplication fails in almost 15% of patients and most of them must be re-operated in order to improve reflux symptoms, esophagitis, or hiatal hernia. Surgical options are to redo LNF, distal gastrectomy alone or combination of both procedures. Redoing LNF, is associated with high rate of postoperative complications and re-failure. Purpose To present the early and medium-term postoperative outcomes of patients submitted to Laparoscopic Toupet Fundoplication combined with Distal Gastrectomy with Roux-en-Y gastrojejunostomy. Methods prospective study including 23 patients submitted to Laparoscopic Nissen Fundoplication who presented recurrence of gastroesophageal reflux after the operation. They were studied with endoscopy, barium swallow, manometry and 24 h pH monitoring in order to determine presence of esophagitis, anatomical deformities, defective Lower Esophageal Sphincter and pathologic acid reflux. Surgical process consisted on re-establishing the anatomy of the esophago-gastric junction, and then perform laparoscopic Toupet fundoplication combined with distal gastrecvtomy and Roux Y gastrojejunostomy. Results After surgery statistically significant improvement regarding heartburn (p < 0.0001), dysphagia (p < 0.0001) and retrosternal chest pain (p < 0.0001) as well as in the endoscopic esophagitis was observed. No significant LES pressure increase after the operation was observed. (from 7.88 + 2.7 to 10.5 + 3.36) (p = 0.15), but the abnormal acid reflux improved significantly after the reoperation, %time pH < 4 decreases from 12.00 + 6.62 to 4.3 + 4.04 (0.0004) and DeMeester score from 44.82 + 21.8 to 11.95 + 5.14 (0.0008) respectively. Conclusion The proposed procedure is safe option to treat successfully patients after failed Nissen fundoplication. Reflux symptoms, esophagitis, presence oh hiatal hernia and reflux score improved after the procedure.

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