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Transoral rotational esophagogastric fundoplication: technical, anatomical, and safety considerations.

Bell RC, Cadière GB - Surg Endosc (2010)

Bottom Line: Gastroesophageal reflux disease (GERD) results primarily from the loss of an effective antireflux barrier, which forms a mechanical barrier against the retrograde movement of gastric content.A key element of the technique involves rotating the fundus around the esophagus with a tissue mold during gastric desufflation.The steps of the technique are described in detail, and suggestions are given about patient selection and care, as well as prevention and management of complications.

View Article: PubMed Central - PubMed

Affiliation: Swedish Medical Center & SurgOne, P.C, 400 W Hampden Place, Suite 230, Englewood, CO 80110, USA. rbell@surgone.com

ABSTRACT

Background: Gastroesophageal reflux disease (GERD) results primarily from the loss of an effective antireflux barrier, which forms a mechanical barrier against the retrograde movement of gastric content. Restoration of the incompetent antireflux barrier is possible by longitudinal and rotational advancement of the gastric fundus about the lower esophagus, creating an esophagogastric fundoplication. This article describes the technique of performing a rotational and longitudinal esophagogastric fundoplication, performed transorally using EsophyX.

Methods: The transoral incisionless fundoplication (TIF) technique enables the creation of a full-thickness esophagogastric fundoplication with fixation extending longitudinally up to 3.5 cm above the Z-line and rotationally more than 270 degrees around the esophagus. A key element of the technique involves rotating the fundus around the esophagus with a tissue mold during gastric desufflation. Anatomic considerations and use of the device's tissue invaginator to push the esophagus caudally are important to ensure safe positioning of the plications below the diaphragm. The steps of the technique are described in detail, and suggestions are given about patient selection and care, as well as prevention and management of complications.

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Anterior rotational plication in two patients illustrating gradual advancement of gastric fundus toward lesser curve 1:30 position
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Fig10: Anterior rotational plication in two patients illustrating gradual advancement of gastric fundus toward lesser curve 1:30 position

Mentions: The device is rotated back toward 6 o’clock and two more rotational anterior plication sets at different plication depths are created using the above movements. This will result in six fasteners being deployed between 1.5 and 2.5 cm above the Z-line, with the most anterior bringing the stomach up around the esophagus to the 1 o’clock to 1:30 position (Fig. 10).Fig. 10


Transoral rotational esophagogastric fundoplication: technical, anatomical, and safety considerations.

Bell RC, Cadière GB - Surg Endosc (2010)

Anterior rotational plication in two patients illustrating gradual advancement of gastric fundus toward lesser curve 1:30 position
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3116120&req=5

Fig10: Anterior rotational plication in two patients illustrating gradual advancement of gastric fundus toward lesser curve 1:30 position
Mentions: The device is rotated back toward 6 o’clock and two more rotational anterior plication sets at different plication depths are created using the above movements. This will result in six fasteners being deployed between 1.5 and 2.5 cm above the Z-line, with the most anterior bringing the stomach up around the esophagus to the 1 o’clock to 1:30 position (Fig. 10).Fig. 10

Bottom Line: Gastroesophageal reflux disease (GERD) results primarily from the loss of an effective antireflux barrier, which forms a mechanical barrier against the retrograde movement of gastric content.A key element of the technique involves rotating the fundus around the esophagus with a tissue mold during gastric desufflation.The steps of the technique are described in detail, and suggestions are given about patient selection and care, as well as prevention and management of complications.

View Article: PubMed Central - PubMed

Affiliation: Swedish Medical Center & SurgOne, P.C, 400 W Hampden Place, Suite 230, Englewood, CO 80110, USA. rbell@surgone.com

ABSTRACT

Background: Gastroesophageal reflux disease (GERD) results primarily from the loss of an effective antireflux barrier, which forms a mechanical barrier against the retrograde movement of gastric content. Restoration of the incompetent antireflux barrier is possible by longitudinal and rotational advancement of the gastric fundus about the lower esophagus, creating an esophagogastric fundoplication. This article describes the technique of performing a rotational and longitudinal esophagogastric fundoplication, performed transorally using EsophyX.

Methods: The transoral incisionless fundoplication (TIF) technique enables the creation of a full-thickness esophagogastric fundoplication with fixation extending longitudinally up to 3.5 cm above the Z-line and rotationally more than 270 degrees around the esophagus. A key element of the technique involves rotating the fundus around the esophagus with a tissue mold during gastric desufflation. Anatomic considerations and use of the device's tissue invaginator to push the esophagus caudally are important to ensure safe positioning of the plications below the diaphragm. The steps of the technique are described in detail, and suggestions are given about patient selection and care, as well as prevention and management of complications.

Show MeSH
Related in: MedlinePlus