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Laparoscopic redo fundoplication for intrathoracic migration of wrap.

Maheshkumar GS, Jani K, Madhankumar MV, Palanivelu C - J Minim Access Surg (2007)

Bottom Line: The classical Barium swallow picture is enclosed.Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology.Confirmation is by a Barium swallow.

View Article: PubMed Central - PubMed

Affiliation: Department of Minimal Access Surgery, GEM Hospital, 45A, Pankaja Mill Road, Coimbatore - 641 045, India.

ABSTRACT
Laparoscopic fundoplication is fast emerging as the treatment of choice of gastro-esophageal reflux disease. However, a complication peculiar to laparoscopic surgery for this disease is the intrathoracic migration of the wrap. This article describes a case of a male patient who developed this particular complication after laparoscopic total fundoplication. Following a trauma, wrap migration occurred. The typical history and symptomatology is described. The classical Barium swallow picture is enclosed. Laparoscopic redo fundoplication was carried out. The difficulties encountered are described. Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology. Confirmation is by a Barium swallow. Treatment is by redo surgery.

No MeSH data available.


Related in: MedlinePlus

Completed re-do hiatal repair
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Figure 0003: Completed re-do hiatal repair

Mentions: A 38-year-old male patient presented with pain and retrosternal discomfort following each meal. Three months previously, he had undergone a laparoscopic Nissen fundoplication with crurorhaphy for a sliding hiatus hernia with gastro-esophageal reflux, diagnosed on endoscopy, manometry and pH study. His postoperative period had been unremarkable and he had been discharged on the second postoperative day. He had remained symptom-free for two months with periodic follow-up (once in 15 days). A month ago, he had a fall on the stairs and the banister of the staircase had struck him in the upper abdomen. He had consulted a local surgeon, who kept him under observation for 48h and then discharged him. Thereafter, he noticed severe pain and epigastric discomfort that increased after meals. At our institute, he was investigated again. Endoscopy revealed a gastric pouch above the hiatal constriction. Barium study confirmed the diagnosis of intrathoracic migration of the fundoplication. [Figure 1]. He was taken for laparoscopic surgery under general anesthesia using the same port sites. Intraoperatively, the crural repair was found to have disrupted, with migration of the wrap into the thorax [Figure 2]. The wrap was reduced back into the abdomen. Some adhesions had to be divided with ultrasonic shears. The crura were re-approximated posteriorly with 1-0 polypropylene interrupted sutures [Figure 3] and the wrap was fixed to the crura in a similar fashion. Intracorporeal suturing technique was used. Postoperatively, the patient had a smooth course, taking liquids on the next day and was discharged after 48h. After three months of follow-up, he is free from symptoms and is able to take a normal diet.


Laparoscopic redo fundoplication for intrathoracic migration of wrap.

Maheshkumar GS, Jani K, Madhankumar MV, Palanivelu C - J Minim Access Surg (2007)

Completed re-do hiatal repair
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2749186&req=5

Figure 0003: Completed re-do hiatal repair
Mentions: A 38-year-old male patient presented with pain and retrosternal discomfort following each meal. Three months previously, he had undergone a laparoscopic Nissen fundoplication with crurorhaphy for a sliding hiatus hernia with gastro-esophageal reflux, diagnosed on endoscopy, manometry and pH study. His postoperative period had been unremarkable and he had been discharged on the second postoperative day. He had remained symptom-free for two months with periodic follow-up (once in 15 days). A month ago, he had a fall on the stairs and the banister of the staircase had struck him in the upper abdomen. He had consulted a local surgeon, who kept him under observation for 48h and then discharged him. Thereafter, he noticed severe pain and epigastric discomfort that increased after meals. At our institute, he was investigated again. Endoscopy revealed a gastric pouch above the hiatal constriction. Barium study confirmed the diagnosis of intrathoracic migration of the fundoplication. [Figure 1]. He was taken for laparoscopic surgery under general anesthesia using the same port sites. Intraoperatively, the crural repair was found to have disrupted, with migration of the wrap into the thorax [Figure 2]. The wrap was reduced back into the abdomen. Some adhesions had to be divided with ultrasonic shears. The crura were re-approximated posteriorly with 1-0 polypropylene interrupted sutures [Figure 3] and the wrap was fixed to the crura in a similar fashion. Intracorporeal suturing technique was used. Postoperatively, the patient had a smooth course, taking liquids on the next day and was discharged after 48h. After three months of follow-up, he is free from symptoms and is able to take a normal diet.

Bottom Line: The classical Barium swallow picture is enclosed.Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology.Confirmation is by a Barium swallow.

View Article: PubMed Central - PubMed

Affiliation: Department of Minimal Access Surgery, GEM Hospital, 45A, Pankaja Mill Road, Coimbatore - 641 045, India.

ABSTRACT
Laparoscopic fundoplication is fast emerging as the treatment of choice of gastro-esophageal reflux disease. However, a complication peculiar to laparoscopic surgery for this disease is the intrathoracic migration of the wrap. This article describes a case of a male patient who developed this particular complication after laparoscopic total fundoplication. Following a trauma, wrap migration occurred. The typical history and symptomatology is described. The classical Barium swallow picture is enclosed. Laparoscopic redo fundoplication was carried out. The difficulties encountered are described. Postoperative wrap migration can be suspected clinically by the presence of a precipitating event and typical symptomatology. Confirmation is by a Barium swallow. Treatment is by redo surgery.

No MeSH data available.


Related in: MedlinePlus