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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

Endoscopic view showing completed Nissen fundoplication and cruroplasty.
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Figure 0003: Endoscopic view showing completed Nissen fundoplication and cruroplasty.

Mentions: The procedure was carried out in the standard fashion with intrathoracic dissection of the oesophagus and the cardia of the stomach, which was brought down below the oesophageal hiatus with adequate length and without tension. The crura were identified and dissected, and short gastric vessels were divided with an ultrasonic shears using the flat blade to mobilise the gastric fundus. Closure of the crura and a floppy Nissen fundoplication were performed with 2/0 polyester (Ethibind, Johnson and Johnson, Mumbai, India) sutures tied intra-corporeally [Figure 3]. The total operative time was 110 minutes. The patient was discharged on first postoperative day after he tolerated oral liquids.


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

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

Endoscopic view showing completed Nissen fundoplication and cruroplasty.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 0003: Endoscopic view showing completed Nissen fundoplication and cruroplasty.
Mentions: The procedure was carried out in the standard fashion with intrathoracic dissection of the oesophagus and the cardia of the stomach, which was brought down below the oesophageal hiatus with adequate length and without tension. The crura were identified and dissected, and short gastric vessels were divided with an ultrasonic shears using the flat blade to mobilise the gastric fundus. Closure of the crura and a floppy Nissen fundoplication were performed with 2/0 polyester (Ethibind, Johnson and Johnson, Mumbai, India) sutures tied intra-corporeally [Figure 3]. The total operative time was 110 minutes. The patient was discharged on first postoperative day after he tolerated oral liquids.

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