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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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Related in: MedlinePlus

EsophyX device. General view of the device (top left) and close views of the working end
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Fig1: EsophyX device. General view of the device (top left) and close views of the working end

Mentions: The EsophyX device (EndoGastric Solutions, Inc., Redmond, WA, USA; Fig. 1) is introduced into the stomach transorally over a flexible endoscope. The device enables molding of tissue and placement of polypropylene suture material in the region of the gastroesophageal (GE) junction. It is composed of a handle, wherein the various controls are located, a chassis of 18 mm in diameter through which the endoscope is inserted and control channels run, side holes on the distal end of the shaft to which external suction can be applied (the tissue invaginator), a tissue mold, which when brought into retroflexion pushes tissue against the shaft of the device, a helical screw, which is advanced into tissue to pull tissue caudally between the tissue mold and the shaft, two stylets, which advance from the shaft of the device through the plicated tissue and then through eyelets in the tissue mold, and a cartridge containing polypropylene H-shaped fasteners (or plicators), which are deployed over the stylets so that the trailing leg engages within the esophageal lumen and the leading leg engages within the gastric lumen.Fig. 1


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

Bell RC, Cadière GB - Surg Endosc (2010)

EsophyX device. General view of the device (top left) and close views of the working end
© Copyright Policy
Related In: Results  -  Collection

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

Fig1: EsophyX device. General view of the device (top left) and close views of the working end
Mentions: The EsophyX device (EndoGastric Solutions, Inc., Redmond, WA, USA; Fig. 1) is introduced into the stomach transorally over a flexible endoscope. The device enables molding of tissue and placement of polypropylene suture material in the region of the gastroesophageal (GE) junction. It is composed of a handle, wherein the various controls are located, a chassis of 18 mm in diameter through which the endoscope is inserted and control channels run, side holes on the distal end of the shaft to which external suction can be applied (the tissue invaginator), a tissue mold, which when brought into retroflexion pushes tissue against the shaft of the device, a helical screw, which is advanced into tissue to pull tissue caudally between the tissue mold and the shaft, two stylets, which advance from the shaft of the device through the plicated tissue and then through eyelets in the tissue mold, and a cartridge containing polypropylene H-shaped fasteners (or plicators), which are deployed over the stylets so that the trailing leg engages within the esophageal lumen and the leading leg engages within the gastric lumen.Fig. 1

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