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Laparoscopic Nissen fundoplication in situs inversus totalis: Technical and ergonomic issues.

Khandelwal RG, Karthikeayan S, Balachandar TG, Reddy PK - J Minim Access Surg (2010)

Bottom Line: Few technical difficulties were encountered during the operation.The position of the primary surgeon, working between the lower limbs of the patient as in case of standard fundoplication, was considered most prudent position to the success of this case.In SIT, this position provides the least visual disorientation from the reversed abdominal organs.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Gastroenterology, Apollo Hospital, Chennai, India.

ABSTRACT
We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) in a patient with situs inversus totalis (SIT). A 34-year-old man was diagnosed with SIT on performing chest X-ray and abdominal sonography as a routine preoperative investigations. He presented with chronic gastro-esophageal reflux disease (GERD) inadequately controlled by medications. The laparoscopic procedure was performed using five ports placed in a mirror-image configuration and with the patient in the modified lithotomy position. Few technical difficulties were encountered during the operation. The position of the primary surgeon, working between the lower limbs of the patient as in case of standard fundoplication, was considered most prudent position to the success of this case. In SIT, this position provides the least visual disorientation from the reversed abdominal organs. We recommend that preoperative detection of SIT is essential to understand the symptomatology of the patient and for planning of any upper abdominal laparoscopic procedure.

No MeSH data available.


Related in: MedlinePlus

X-ray chest showing dextrocardia and gastric air bubble on right side i.e. situs inversus totalis.
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Figure 0001: X-ray chest showing dextrocardia and gastric air bubble on right side i.e. situs inversus totalis.

Mentions: A 34-year-old man presented with a 3-year history of symptoms consistent with GERD. His symptoms were initially controlled with proton-pump inhibitors but deteriorated in last 6 months. A chest X-ray detected SIT [Figure 1]. Oesophago-gastroduodenoscopy confirmed reflux oesophagitis with a lax lower oesophageal sphincter and sliding hiatal hernia. Patient did not cooperate for oesophageal manometry and 24 hour pH study. Nuclear gastroesophageal reflux study showed grade III reflux and hiatus hernia. The patient was offered a Nissen fundoplication. This was caried out with the patient in modified lithotomy position, which is the position we prefer for all cases of laparoscopic Nissen fundoplication. The ports were placed in a configuration that was the mirror image of our usual fundoplication procedure. One 10-mm supraumbilical camera port, 5-mm epigastric port for a Nathanson’s retractor, one 10-mm left midclavicular port and two 5-mm accessory ports below the right subcostal margin were placed. The surgeon stood in between the legs of the patient. The assistant worked from the right side of the patient, opposite his usual position. The intra-abdominal organs were visualized and SIT was confirmed [Figure 2].


Laparoscopic Nissen fundoplication in situs inversus totalis: Technical and ergonomic issues.

Khandelwal RG, Karthikeayan S, Balachandar TG, Reddy PK - J Minim Access Surg (2010)

X-ray chest showing dextrocardia and gastric air bubble on right side i.e. situs inversus totalis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2992661&req=5

Figure 0001: X-ray chest showing dextrocardia and gastric air bubble on right side i.e. situs inversus totalis.
Mentions: A 34-year-old man presented with a 3-year history of symptoms consistent with GERD. His symptoms were initially controlled with proton-pump inhibitors but deteriorated in last 6 months. A chest X-ray detected SIT [Figure 1]. Oesophago-gastroduodenoscopy confirmed reflux oesophagitis with a lax lower oesophageal sphincter and sliding hiatal hernia. Patient did not cooperate for oesophageal manometry and 24 hour pH study. Nuclear gastroesophageal reflux study showed grade III reflux and hiatus hernia. The patient was offered a Nissen fundoplication. This was caried out with the patient in modified lithotomy position, which is the position we prefer for all cases of laparoscopic Nissen fundoplication. The ports were placed in a configuration that was the mirror image of our usual fundoplication procedure. One 10-mm supraumbilical camera port, 5-mm epigastric port for a Nathanson’s retractor, one 10-mm left midclavicular port and two 5-mm accessory ports below the right subcostal margin were placed. The surgeon stood in between the legs of the patient. The assistant worked from the right side of the patient, opposite his usual position. The intra-abdominal organs were visualized and SIT was confirmed [Figure 2].

Bottom Line: Few technical difficulties were encountered during the operation.The position of the primary surgeon, working between the lower limbs of the patient as in case of standard fundoplication, was considered most prudent position to the success of this case.In SIT, this position provides the least visual disorientation from the reversed abdominal organs.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Gastroenterology, Apollo Hospital, Chennai, India.

ABSTRACT
We report a laparoscopic Nissen fundoplication for gastroesophageal reflux disease (GERD) in a patient with situs inversus totalis (SIT). A 34-year-old man was diagnosed with SIT on performing chest X-ray and abdominal sonography as a routine preoperative investigations. He presented with chronic gastro-esophageal reflux disease (GERD) inadequately controlled by medications. The laparoscopic procedure was performed using five ports placed in a mirror-image configuration and with the patient in the modified lithotomy position. Few technical difficulties were encountered during the operation. The position of the primary surgeon, working between the lower limbs of the patient as in case of standard fundoplication, was considered most prudent position to the success of this case. In SIT, this position provides the least visual disorientation from the reversed abdominal organs. We recommend that preoperative detection of SIT is essential to understand the symptomatology of the patient and for planning of any upper abdominal laparoscopic procedure.

No MeSH data available.


Related in: MedlinePlus