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NISSEN FUNDOPLICATION
Dr. M. M. Gazayerli is presenting his technique of Laparoscopic Nissen Fundoplication in a 35 year old female. This patient was suffering from gastroesophageal reflux disease and failed medical treatment. An esophagogastroduodenoscopy revealed severe esophagitis with significant reflux.
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The operation starts by dividing the gastrohepatic and phrenoesophageal ligaments exposing the GE junction.
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The right crura has been disected free, and the esophagus is being recognized.
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An arterial vessel is being divided between clips to allow better mobilization of the stomach
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The right and left cruras are sutured with interrupted stitches to reduce the hiatus.
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The stomach is grasped from behind the esophagus, without manipulating it to avoid injury. The objective is to obtain a 360 degree "stomach-wrap" around the esophagus (fundoplication).
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Number "0" Ethibond stitch are placed between both gastric flaps.
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The Nissen wrap is anchored to the esophagus to avoid sliding.
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Stiches are tied off in an extra corporeal fashion using the "Knot Tier" instrument designed by Dr. Gazayerli.
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This picture shows a tension free the Nissen Fundoplication.
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