Complete fixed non-deformable fundoplication with posterior esophageal gastropexy

Patients undergoing gastrointestinal surgery had only two surgical options: conventional open surgery or laparoscopic surgery with multiple incisions. Single incision laparoscopic surgery may become the preferred method of the future. Patients experience less pain and quicker recovery. Patients also enjoy the cosmetic benefit of fewer visible postoperative scars. This video shows a SILS Nissen fundoplication respecting all steps of the conventional approach.

Since the first operation performed in 2005, single incision laparoscopic surgery has been used around the world to perform many procedures. Problems still remain for exposure. This video shows a single incision laparoscopic Nissen fundoplication with new curved and reusable instruments.

This video shows a reintervention after laparoscopic Nissen-Rossetti due to failure of the technique in a 70-year-old woman presenting with a history of dysphagia and weight loss beginning short after surgery.
First, dissection of the fundic wrap and esophageal hiatus are completed in order to expose specific anatomical landmarks that would help us understand the possible causes for the failure of the first procedure.
The original fundoplication is then unwrapped, rearranging it to the original anatomical position. This maneuver allows us to understand the causes for the technique’s failure, which can be accounted for by the asymmetrical position of the fundoplication caused by a series of elements. First, the short gastric vessels were not dissected during the first surgery, this probably contributed to the malposition of the right flap, which emerges from the posterior mid-stomach wall, distal to the fundus. On the other hand, the right flap emerges from the para-esophageal proximal edge of the lesser curvature; this causes the “valve” to be angulated and rotated clockwise, “hiding” the fundoplication on the posterior gastric wall.
To complete the procedure, a Toupet fundoplication is performed as a substituting anti-reflux technique.

In this live interactive surgery video, Dr. Silvana Perretta presents the clinical case of a patient with GERD. Dr. Bernard Dallemagne demonstrates the main principles of a Nissen fundoplication for GERD, covering all aspects of the surgical procedure including key steps. The Endolumenal Functional Lumen Imaging Probe Imaging System (EndoFLIP) is used for intelligent monitoring of anatomical structures. The fundoplication and valve construction are better visualized by means of intraoperative endoscopy.

In this key lecture, Dr. DeMeester looks into the prevention and treatment of the side effects following a laparoscopic fundoplication. He mainly covers dysphagia and gas bloat syndrome in post-Nissen fundoplications using different studies. He lays emphasis on LES physiology in pre- and post-Nissen fundoplication and provides treatment options for related symptoms.