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Laparoscopic Partial Fundoplication in Case of Gastroesophageal Reflux Disease Patient with Absent Esophageal Motility.

Seo KW, Park MI, Yoon KY, Park SJ, Kim SE - J Gastric Cancer (2015)

Bottom Line: The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated.After surgery, his subjective symptoms improved.Furthermore, objective findings including manometry and 24-hour pH-metry also improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kosin University College of Medicine, Busan, Korea.

ABSTRACT
The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated. We report a case of antireflux surgery performed in a patient with absent esophageal motility as categorized by the Chicago classification (2011). A 54-year-old man underwent laparoscopic Toupet fundoplication due to apparent GERD and desire to discontinue all medications. After surgery, his subjective symptoms improved. Furthermore, objective findings including manometry and 24-hour pH-metry also improved. In our experience, antireflux surgery can improve GERD symptoms patients, even with absent esophageal motility.

No MeSH data available.


Related in: MedlinePlus

Intraoperative photograph of completion of the Toupet fundoplication (A) and schematic (B).
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Figure 4: Intraoperative photograph of completion of the Toupet fundoplication (A) and schematic (B).

Mentions: Under general anesthesia, the patient was placed in a supine position, and the surgeon stood on the right side of the patient. Pneumoperitoneum was induced and maintained at 12 mmHg using a Veress needle. Four trocars (two 10 mm and two 5 mm) were inserted. Using the reverse Trendelenburg position, the procedure started by dividing short gastric vessels from the low pole of the spleen to the angle of His. The procedure continued to the lesser omentum high enough to not cut the vagal branch to the liver. After identification of the anterior vagal nerve, the gastrophrenic ligament was divided. The dissection was then continued from right to left behind the esophagus until the crura was exposed and the angle of His was detached. At this point, a posterior window was created large enough to easily wrap using umbilical tape. After ensuring sufficient wrap placement, cruroplasty was accomplished with three simple intracorporeal nonabsorbable sutures using 3-0 Ethibond. The 2-cm-long partial Toupet wrap was completed using the anterior wall of the gastric fundus. After the leading edge of the fundus was pulled posteriorly, the fundus was sutured to the right side of the esophagus over a length of 2 cm. The anterior fundus was sutured to the left side of the esophagus over the same spacing length with 90° distance between both wraps. The right side of the wrap was anchored to the hiatus to prevent intrathoracic migration of the wrap. After confirming hemostasis and the absence of other immediate complications, the operation was completed (Fig. 4).


Laparoscopic Partial Fundoplication in Case of Gastroesophageal Reflux Disease Patient with Absent Esophageal Motility.

Seo KW, Park MI, Yoon KY, Park SJ, Kim SE - J Gastric Cancer (2015)

Intraoperative photograph of completion of the Toupet fundoplication (A) and schematic (B).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4496439&req=5

Figure 4: Intraoperative photograph of completion of the Toupet fundoplication (A) and schematic (B).
Mentions: Under general anesthesia, the patient was placed in a supine position, and the surgeon stood on the right side of the patient. Pneumoperitoneum was induced and maintained at 12 mmHg using a Veress needle. Four trocars (two 10 mm and two 5 mm) were inserted. Using the reverse Trendelenburg position, the procedure started by dividing short gastric vessels from the low pole of the spleen to the angle of His. The procedure continued to the lesser omentum high enough to not cut the vagal branch to the liver. After identification of the anterior vagal nerve, the gastrophrenic ligament was divided. The dissection was then continued from right to left behind the esophagus until the crura was exposed and the angle of His was detached. At this point, a posterior window was created large enough to easily wrap using umbilical tape. After ensuring sufficient wrap placement, cruroplasty was accomplished with three simple intracorporeal nonabsorbable sutures using 3-0 Ethibond. The 2-cm-long partial Toupet wrap was completed using the anterior wall of the gastric fundus. After the leading edge of the fundus was pulled posteriorly, the fundus was sutured to the right side of the esophagus over a length of 2 cm. The anterior fundus was sutured to the left side of the esophagus over the same spacing length with 90° distance between both wraps. The right side of the wrap was anchored to the hiatus to prevent intrathoracic migration of the wrap. After confirming hemostasis and the absence of other immediate complications, the operation was completed (Fig. 4).

Bottom Line: The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated.After surgery, his subjective symptoms improved.Furthermore, objective findings including manometry and 24-hour pH-metry also improved.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Kosin University College of Medicine, Busan, Korea.

ABSTRACT
The surgical indications for the treatment of gastroesophageal reflux disease (GERD) in patients with esophageal motility disorders have been debated. We report a case of antireflux surgery performed in a patient with absent esophageal motility as categorized by the Chicago classification (2011). A 54-year-old man underwent laparoscopic Toupet fundoplication due to apparent GERD and desire to discontinue all medications. After surgery, his subjective symptoms improved. Furthermore, objective findings including manometry and 24-hour pH-metry also improved. In our experience, antireflux surgery can improve GERD symptoms patients, even with absent esophageal motility.

No MeSH data available.


Related in: MedlinePlus