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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

A TIF 1 procedure with gastrogastric plications placed at the level of the Z-line. B TIF 2 technique creates an esophagogastric fundoplication proximal to the Z-line
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Fig2: A TIF 1 procedure with gastrogastric plications placed at the level of the Z-line. B TIF 2 technique creates an esophagogastric fundoplication proximal to the Z-line

Mentions: Initial descriptions of the transoral incisionless fundoplication (TIF) technique involved reduction of any hiatal hernia by gripping the esophagus with the chassis’ tissue invaginator and advancing the device caudally, and then creation of a full-thickness gastrogastric plication at the level of the Z-line (Fig. 2A). The helical retractor was used to pull full-thickness gastric wall caudally into the tissue mold. The mold apposed the two layers of gastric wall and sandwiched between them the phrenoesophageal membrane, which could be demonstrated in the canine model and observed in human cases [5]. Subsequently, polypropylene fasteners were deployed over their respective stylets. This created a partially circumferential fundoplication but was limited to gastric tissue, and was dubbed “ELF”—endoluminal fundoplication—and later “TIF.”Fig. 2


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

Bell RC, Cadière GB - Surg Endosc (2010)

A TIF 1 procedure with gastrogastric plications placed at the level of the Z-line. B TIF 2 technique creates an esophagogastric fundoplication proximal to the Z-line
© Copyright Policy
Related In: Results  -  Collection

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

Fig2: A TIF 1 procedure with gastrogastric plications placed at the level of the Z-line. B TIF 2 technique creates an esophagogastric fundoplication proximal to the Z-line
Mentions: Initial descriptions of the transoral incisionless fundoplication (TIF) technique involved reduction of any hiatal hernia by gripping the esophagus with the chassis’ tissue invaginator and advancing the device caudally, and then creation of a full-thickness gastrogastric plication at the level of the Z-line (Fig. 2A). The helical retractor was used to pull full-thickness gastric wall caudally into the tissue mold. The mold apposed the two layers of gastric wall and sandwiched between them the phrenoesophageal membrane, which could be demonstrated in the canine model and observed in human cases [5]. Subsequently, polypropylene fasteners were deployed over their respective stylets. This created a partially circumferential fundoplication but was limited to gastric tissue, and was dubbed “ELF”—endoluminal fundoplication—and later “TIF.”Fig. 2

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