Lap Fundoplication

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

Surgical Procedure: Laparoscopic Hernia-Hiatus Hernia

Location: Yashoda Hospital, Hyderabad Somajiguda, Hyderabad


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 :

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


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

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