Lap Fundoplication

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Surgeon(s)/Speaker(s): Dr. Lakshmi Kona

Surgical Procedure: Laparoscopic Hernia-Hiatus Hernia

Location: Yashoda Hospital, Hyderabad Somajiguda, Hyderabad

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Indexsteps

3. • 5 mm laparoscope inserted through the left paramedian port :

4. • Port placement (as shown in the image) :

5. • Left lobe of liver retracted :

6. • Dissection of gastro-hepatic ligament :

7. • Identification of right crus of diaphragm :

9. • Creation of retro-oesophageal window :

10. • Opening lesser sac :

11. • Dissection of the fundus and short gastric arteries from spleen and diaphragm :

12. • Left crus dissected :

13. • Mediastinal mobilisation of the oesophagus :

14. • Approximation of hiatus :

15. • Delivery of fundus through the retro-oesophageal window :

16. • Show shining manoeuvre :

17. • Suturing of the fundus to the lower oesophagus :

18. • Haemostasis was ensured and ports closed :

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port positions

1. Port position : • epigastric port for left lobe of liver retraction • Retraction port in the left hypochondrium • Camera port in left paramedian position • 1st working port in right paramedian position • 2nd working port in right hypochondrium

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pre_post_measures

1. Preoperative investigations : Routine blood workup – Complete blood count, kidney function test, PT/INR, and testing for Hep C, HIV and HBsAg (via rapid card) :new:Radiological investigations – X-ray chest (PA view) :new:Endoscopic investigations – -upper GI endoscopy – rule our stricture, Barrett's oesophagus, carcinoma, dysplasia -oesophageal manometry – for identifying ineffective oesophageal peristalsis, and misdiagnosis of achalasia. -oesophageal pH testing – for GERD or for patients with oesophagitis not responding to PPIs

2. Preoperative measures : Trial of PPIs for 6 weeks preoperatively :new:Fasting for 6 hours :new:Anaesthesia – GA + TAP block :new:The patient is supine, and secured to the table with pressure points padded :new:Single shot surgical antibiotic prophylaxis followed :new:Warmer and DVT pump attached

3. Postoperative measures : Allow liquid diet in 4-6 hours, followed by soft diet and normal diet in 6-8 hours. :new:The patient can mobilise from that evening itself

4. Warning signs in the postoperative period : Look for chest pain or crepitations in the chest which could be due to mediastinitis or oesophageal perforation :new:Look for excessive belching/nausea :new:Watch for signs of bleeding as there can be reactionary bleeding from the short gastric arteries

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Surgical Instruments

1. 10mm Trocar

2. Liver Retractor

3. video camera unit

4. Ultrasonic dissector

5. 5mm Needle Holder

6. Needle drivers

7. Needle

8. Suture