The efficacy of Heller’s esophagocardiomyotomy with Dor la esofagocardiomiotomía de Heller con funduplicatura de Dor por laparoscopia. Miotomía de Heller con funduplicatura laparoscópica (tratamiento Visick Score was as follows: grade I, six patients ( %, Dor four patients. A Nissen fundoplication, or laparoscopic Nissen fundoplication when performed via In a Dor (anterior) fundoplication, the fundus is laid over the top of the.
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A Nissen fundoplicationor laparoscopic Nissen fundoplication when performed via laparoscopic surgeryis a surgical procedure to treat gastroesophageal reflux disease GERD and hiatal hernia.
In GERD, it is usually performed when medical therapy has failed; but, with a Type II paraesophageal hiatus herniait is the first-line procedure. Rudolph Nissen — first performed the procedure in and published the results of two cases in a Swiss Medical Weekly. The procedure has borne his name since it ror popularity in the s. In a fundoplicationthe gastric fundus upper part of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter.
The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm.
In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped the entire degrees around the esophagus. In contrast, surgery for achalasia is generally accompanied by either a Dor or Toupet partial fundoplication, which is less likely than a Nissen wrap to aggravate the dysphagia that characterizes achalasia.
In a Dor anterior fundoplication, the fundus is laid over the top of the esophagus; while in a Toupet posterior fundoplication, the fundus is wrapped around the back of the esophagus. The procedure is now routinely performed laparoscopically. When used to alleviate gastroesophageal funduppicatura symptoms in patients with delayed gastric emptyingit is frequently combined with modification of the pylorus via pyloromyotomy or pyloroplasty.
Whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it.
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This prevents the reflux of gastric acid in GERD. Although antacids and PPI drug therapy can reduce the effects of reflux acid, successful surgical treatment has the advantage of eliminating drug side-effects and damaging effects from other components of reflux such as bile or gastric contents. Studies have shown that after 10 years, Complications include “gas bloat syndrome”, dysphagia trouble swallowingdumping syndromeexcessive scarring, vagus nerve injury and, rarely, achalasia.
If the symptoms warrant a repeat surgery, the surgeon may use Marlex or another form of artificial mesh to strengthen the connection.
In “gas bloat syndrome”, fundoplication can alter the mechanical ability of the stomach to eliminate swallowed air by belchingleading to an accumulation of gas in the stomach or small intestine. The offending gas may also come from dietary sources especially carbonated beveragesor involuntary swallowing of air aerophagia.
If postoperative gas-bloat syndrome does not resolve with time, dietary restrictions, counselling regarding aerophagia, and correction — either by endoscopic balloon dilatation [ citation needed ] or repeat surgery to revise the Nissen fundoplication to a partial fundoplication — may be necessary.
Vomiting is sometimes impossible or, if not, very painful after a fundoplication, with the likelihood of this complication typically decreasing in the months after surgery. In some cases, the purpose of this operation is to correct excessive vomiting.
However, when its purpose is to reduce gastric reflux, difficulty in vomiting may be an undesired outcome. Initially, vomiting is impossible; however, small amounts of vomit may be produced after the wrap settles over time, and in extreme cases such as alcohol poisoning or food poisoningthe patient may be able to vomit freely with some amount of pain.
Outcomes have improved in recent years, especially at the most skilled and successful clinics [ citation needed ].
Gastroenterology Research and Practice
From Wikipedia, the free encyclopedia. Nissen fundoplication Diagram of a Nissen fundoplication. Schweizerische Medizinische Wochenschrift in German. The American Journal of Digestive Diseases. From Bowditch to Laparoscopy”. Esophagogastroduodenoscopy Barium swallow Upper gastrointestinal series. Bariatric fuduplicatura Duodenal switch Jejunoileal bypass Bowel resection Ileostomy Intestine transplantation Jejunostomy Partial ileal bypass surgery Strictureplasty.
Appendicectomy Colectomy Colonic polypectomy Colostomy Hartmann’s operation.
Anal sphincterotomy Anorectal manometry Lateral internal sphincterotomy Rubber band ligation Transanal hemorrhoidal dearterialization. Colonoscopy Anoscopy Capsule endoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominal ultrasonography Defecography Double-contrast barium enema Endoanal ultrasound Enteroclysis Lower gastrointestinal series Small-bowel follow-through Transrectal ultrasonography Virtual colonoscopy.
Fecal fat test Fecal pH test Stool guaiac test. Artificial extracorporeal liver support Bioartificial liver devices Liver dialysis Hepatectomy Liver biopsy Liver transplantation Portal hypertension Transjugular intrahepatic portosystemic shunt [TIPS] Distal splenorenal shunt procedure. Frey’s procedure Pancreas transplantation Pancreatectomy Pancreaticoduodenectomy Puestow procedure.
Diagnostic peritoneal lavage Intraperitoneal injection Laparoscopy Omentopexy Paracentesis Peritoneal dialysis. Inguinal hernia surgery Femoral hernia repair.
Diagram of a Nissen fundoplication. Small bowel Bariatric surgery Fnuduplicatura switch Jejunoileal bypass Bowel funduplcatura Ileostomy Intestine transplantation Jejunostomy Partial ileal bypass surgery Strictureplasty. Liver Artificial extracorporeal liver support Bioartificial liver devices Liver dialysis Hepatectomy Liver biopsy Liver transplantation Portal hypertension Transjugular intrahepatic portosystemic shunt [TIPS] Distal splenorenal shunt procedure.
Peritoneum Diagnostic peritoneal lavage Intraperitoneal injection Laparoscopy Omentopexy Paracentesis Peritoneal dialysis.