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Laparoscopic redo Nissen for recurrent GERD not responding to PPIs
This video demonstrates a redo laparoscopic Nissen fundoplication in a 34-year-old man with recurrent gastroesophageal reflux symptoms. A first laparoscopic Nissen-Rossetti procedure was performed ten years ago, and was taken down 2 months after surgery for severe dysphagia and important weight loss.
The success rate of laparoscopic Nissen fundoplication depends on the proper creation of a floppy and symmetric wrap together with a suitable crural repair. Most failures and complications due to technical mistakes during antireflux surgeries are related to an incomplete or inadequate intraoperative evaluation of the wrap and crural repair. Development or persistence of dysphagia after fundoplication is among the most common complications occurring in up to 30% of patients. Surgical factors responsible for de novo dysphagia are mainly related to the degree, tightness, length of the fundoplication and technical errors leading to wrap misconstruction -below the anatomical gastroesophageal junction or by a distortion of the esophageal diameter and orientation at the level of the crural repair.
B Dallemagne, S Perretta, J Marescaux
Surgical intervention
9 years ago
1618 views
27 likes
0 comments
09:41
Laparoscopic redo Nissen for recurrent GERD not responding to PPIs
This video demonstrates a redo laparoscopic Nissen fundoplication in a 34-year-old man with recurrent gastroesophageal reflux symptoms. A first laparoscopic Nissen-Rossetti procedure was performed ten years ago, and was taken down 2 months after surgery for severe dysphagia and important weight loss.
The success rate of laparoscopic Nissen fundoplication depends on the proper creation of a floppy and symmetric wrap together with a suitable crural repair. Most failures and complications due to technical mistakes during antireflux surgeries are related to an incomplete or inadequate intraoperative evaluation of the wrap and crural repair. Development or persistence of dysphagia after fundoplication is among the most common complications occurring in up to 30% of patients. Surgical factors responsible for de novo dysphagia are mainly related to the degree, tightness, length of the fundoplication and technical errors leading to wrap misconstruction -below the anatomical gastroesophageal junction or by a distortion of the esophageal diameter and orientation at the level of the crural repair.
Collis Nissen for slipped fundoplication with recurrent GERD symptoms
Hiatal hernia recurrence is a dreaded postoperative complication after surgery for gastroesophageal reflux. This video presents a live surgery performed in a patient presenting with recurrent symptoms and dysphagia after a previous Nissen fundoplication that was performed 5 years ago. All the preoperative work-up demonstrates the recurrent reflux, mixed ascites, and alkaline reflux associated with an intrathoracic migration of the proximal stomach, and probably a slippage of the valve on the upper part of the stomach. This patient has a manometry, which confirmed the weakness of the lower esophageal sphincter (LES) associated with some dysmotility disorders in the lower esophagus.
B Dallemagne, J Marescaux
Surgical intervention
10 years ago
1917 views
15 likes
0 comments
17:24
Collis Nissen for slipped fundoplication with recurrent GERD symptoms
Hiatal hernia recurrence is a dreaded postoperative complication after surgery for gastroesophageal reflux. This video presents a live surgery performed in a patient presenting with recurrent symptoms and dysphagia after a previous Nissen fundoplication that was performed 5 years ago. All the preoperative work-up demonstrates the recurrent reflux, mixed ascites, and alkaline reflux associated with an intrathoracic migration of the proximal stomach, and probably a slippage of the valve on the upper part of the stomach. This patient has a manometry, which confirmed the weakness of the lower esophageal sphincter (LES) associated with some dysmotility disorders in the lower esophagus.
Laparoscopic Tanner’s gastropexy for acute gastric volvulus
Acute gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180 degrees, creating a closed loop obstruction that can result in incarceration and/or strangulation. The most common causes of gastric volvulus in adults are diaphragmatic defects such as paraesophageal hernias. Historically, mortality rates of 30-50% have been reported for acute volvulus, with the major cause of death being strangulation, which can lead to necrosis and perforation. Emergent surgical intervention is indicated for acute gastric volvulus. The laparoscopic treatment requires considerable experience but it has the potential to decrease the morbidity associated with open procedures. In February 2009, a case of an organo-axial gastric volvulus with a giant hiatal hernia was published in WeBSurg. We would like to take advantage of this to present a case with a mesentero-axial type marking the difference of the pathophysiology.
J Torres Bermúdez, S del Valle Ruiz , J Lopez Espejo, G Sánchez de la Villa
Surgical intervention
10 years ago
3882 views
41 likes
0 comments
12:27
Laparoscopic Tanner’s gastropexy for acute gastric volvulus
Acute gastric volvulus is a rare clinical entity defined as an abnormal rotation of the stomach of more than 180 degrees, creating a closed loop obstruction that can result in incarceration and/or strangulation. The most common causes of gastric volvulus in adults are diaphragmatic defects such as paraesophageal hernias. Historically, mortality rates of 30-50% have been reported for acute volvulus, with the major cause of death being strangulation, which can lead to necrosis and perforation. Emergent surgical intervention is indicated for acute gastric volvulus. The laparoscopic treatment requires considerable experience but it has the potential to decrease the morbidity associated with open procedures. In February 2009, a case of an organo-axial gastric volvulus with a giant hiatal hernia was published in WeBSurg. We would like to take advantage of this to present a case with a mesentero-axial type marking the difference of the pathophysiology.
Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
M Vix, F Costantino, J Marescaux
Surgical intervention
11 years ago
729 views
31 likes
0 comments
12:17
Laparoscopic Roux-en-Y gastric bypass after vertical banded gastroplasty
Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge.
Laparoscopic vertical banded gastroplasty (VBG) is associated with high revisional rates. In the case of failed VBG, repeat VBG seems to be a poor option and conversion to gastric bypass yields better results.
This is the case of a 35-year-old female patient who underwent a vertical banded gastroplasty by laparotomy 8 years ago and presents with dysphagia. A gastroscopy and a contrast swallow exam using radio-opaque markers do not show any fistulas, but peroperative surgical exploration discovers a gastro-gastric fistula. This video clearly shows all the technical aspects of a revisional bariatric procedure.
Giant hiatal hernia: acute presentation with gastric volvulus
Hiatal hernia is a common disorder of the digestive tract. Most patients are elderly and with significant co-morbidities. Historically, the surgical repair of paraesophageal hernias (PHH) has been advocated regardless of the presence of symptoms. In fact, despite patients being symptom-free, the development of potentially life-threatening complications such as obstruction, acute dilatation, perforation, or bleeding of the stomach mucosa, is well-known and has proven to be fatal in 27% of cases. Nevertheless, patients with asymptomatic PHH are likely to develop symptoms needing emergency surgery in only 1.16% of cases with a 5.4% mortality rate. Recently, several authors have questioned the indication for repair in asymptomatic patients and prefer to monitor asymptomatic or minimally symptomatic PHH by ‘watchful waiting’. Our current practice is to operate only in the case symptoms or complications. The laparoscopic repair of PHH is certainly technically challenging. It requires considerable experience with minimally invasive surgery of the foregut, and a complete understanding of esophageal pathophysiology. The basic principles of surgical repair are the reduction of herniated stomach and distal esophagus into the abdominal cavity with tension-free repositioning of 2cm of lower esophagus in a subphrenic position, complete excision of the peritoneal hernia sac from the mediastinum and the repair of the diaphragmatic hiatus.
This is the case of a woman admitted to the emergency room for complete acute dysphagia associated with type IV paraesophageal hernia. The preoperative work-up (CT-scan, upper GI series) showed the migration of the stomach, left transverse colon and omentum into the chest.
B Dallemagne, S Perretta, J Marescaux
Surgical intervention
11 years ago
2801 views
80 likes
0 comments
15:02
Giant hiatal hernia: acute presentation with gastric volvulus
Hiatal hernia is a common disorder of the digestive tract. Most patients are elderly and with significant co-morbidities. Historically, the surgical repair of paraesophageal hernias (PHH) has been advocated regardless of the presence of symptoms. In fact, despite patients being symptom-free, the development of potentially life-threatening complications such as obstruction, acute dilatation, perforation, or bleeding of the stomach mucosa, is well-known and has proven to be fatal in 27% of cases. Nevertheless, patients with asymptomatic PHH are likely to develop symptoms needing emergency surgery in only 1.16% of cases with a 5.4% mortality rate. Recently, several authors have questioned the indication for repair in asymptomatic patients and prefer to monitor asymptomatic or minimally symptomatic PHH by ‘watchful waiting’. Our current practice is to operate only in the case symptoms or complications. The laparoscopic repair of PHH is certainly technically challenging. It requires considerable experience with minimally invasive surgery of the foregut, and a complete understanding of esophageal pathophysiology. The basic principles of surgical repair are the reduction of herniated stomach and distal esophagus into the abdominal cavity with tension-free repositioning of 2cm of lower esophagus in a subphrenic position, complete excision of the peritoneal hernia sac from the mediastinum and the repair of the diaphragmatic hiatus.
This is the case of a woman admitted to the emergency room for complete acute dysphagia associated with type IV paraesophageal hernia. The preoperative work-up (CT-scan, upper GI series) showed the migration of the stomach, left transverse colon and omentum into the chest.
Single Incision Laparoscopic Surgery (SILS): gastric banding removal for acute gastric pouch dilatation
In a significantly short time, Laparoscopic Adjustable Gastric Banding (LAGB) for morbid obesity has become a common operation in Europe and elsewhere.
Recent series show a high percentage of patients re-operated on, almost always with excision of the banding system. The reasons for re-operation are esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation.
This video demonstrates the removal of a gastric band for acute gastric pouch dilatation. The procedure was completed using a single access technique, with conventional laparoscopic instrumentation. A 2cm incision is performed on the port site and the same one is removed first maintaining the connection tube on site in order to place traction on the band. A 10mm port is inserted using an open technique, and two further 5mm ports are placed anteriorly just to the left and to the right side of the previous one.
N Perrotta, A Cappiello, C Giudicianni, N Andriulo, T Marinelli, D Loffredo
Surgical intervention
10 years ago
2949 views
9 likes
0 comments
06:06
Single Incision Laparoscopic Surgery (SILS): gastric banding removal for acute gastric pouch dilatation
In a significantly short time, Laparoscopic Adjustable Gastric Banding (LAGB) for morbid obesity has become a common operation in Europe and elsewhere.
Recent series show a high percentage of patients re-operated on, almost always with excision of the banding system. The reasons for re-operation are esophagitis, band erosion, pouch dilatation, leakage from the balloon, and esophageal dilatation.
This video demonstrates the removal of a gastric band for acute gastric pouch dilatation. The procedure was completed using a single access technique, with conventional laparoscopic instrumentation. A 2cm incision is performed on the port site and the same one is removed first maintaining the connection tube on site in order to place traction on the band. A 10mm port is inserted using an open technique, and two further 5mm ports are placed anteriorly just to the left and to the right side of the previous one.