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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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Retroflex endoscopic view of gastroesophageal valve with clock face annotations. The lesser curve is defined as 12 o’clock
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Fig5: Retroflex endoscopic view of gastroesophageal valve with clock face annotations. The lesser curve is defined as 12 o’clock

Mentions: Anatomic relations both within the stomach and to external organs, such as liver, spleen, aorta, heart, and left and right crura, are not always self-evident during flexible upper gastrointestinal endoscopy. To aid with orientation, we propose a terminology using the clock face. On endoscopy in retroflex view the 12 o’clock position is defined as the location of the lesser curve. Six o’clock refers to the valve position, which faces the greater curve of the stomach (Fig. 5).Fig. 5


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

Bell RC, Cadière GB - Surg Endosc (2010)

Retroflex endoscopic view of gastroesophageal valve with clock face annotations. The lesser curve is defined as 12 o’clock
© Copyright Policy
Related In: Results  -  Collection

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

Fig5: Retroflex endoscopic view of gastroesophageal valve with clock face annotations. The lesser curve is defined as 12 o’clock
Mentions: Anatomic relations both within the stomach and to external organs, such as liver, spleen, aorta, heart, and left and right crura, are not always self-evident during flexible upper gastrointestinal endoscopy. To aid with orientation, we propose a terminology using the clock face. On endoscopy in retroflex view the 12 o’clock position is defined as the location of the lesser curve. Six o’clock refers to the valve position, which faces the greater curve of the stomach (Fig. 5).Fig. 5

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