What is Laparoscopic Fundoplication? скачать в хорошем качестве

What is Laparoscopic Fundoplication?

Your lower esophageal sphincter is the valve between your esophagus and stomach. It is possible for your sphincter to be too loose or for the opening in the diaphragm muscles around it to be too wide, allowing for acid reflux or even herniation/bulging of your stomach through this opening into your chest. These conditions can damage your esophagus and cause discomfort. This sphincter can be tightened surgically by wrapping the top portion of the stomach around your esophageal sphincter to reinforce the valve; this will prevent acid reflux and allow your esophagus to heal. If you also have a hiatal hernia, this will be repaired during the same procedure. Many important structures surround the area of operation; your stomach is held in place by multiple ligaments attaching it to surrounding organs and these must be taken down. Several important nerves and arteries are near the area of dissection and care must be taken not to damage these. Above the diaphragm, your esophagus lies between your lungs. If less invasive medical treatments fail, fundoplication is commonly performed for GERD or acid reflux disease because tightening your esophageal sphincter can help stop backflow of acid into your esophagus. Fundoplications are also commonly performed as part of hiatal hernia repair. Your esophageal acid levels and esophageal muscle function will be tested prior to surgery to check whether this surgery will help your symptoms and to determine the best strength of wrap for you. What to expect - Preop : Your surgery will be done in an operating room while you are completely asleep. The length of the procedure can vary but is usually 3-5 hours. It is usually done through small incisions with the help of a long camera. We call this laparoscopic surgery. Once we have entered your abdomen, we retract your liver out of the way and carefully dissect away ligaments and adhesions until we have exposed the stomach and the cruz of the diaphragm, or the opening in your diaphragm muscles through which your esophagus should pass. We then free up the stomach until it can be mobilized enough to wrap around the esophageal sphincter. We also free up the esophagus where it lies in the lower part of the chest so it can be carefully retracted out of the way. We then partially sew the cruz of the diaphragm together so the opening in your diaphragm becomes a little tighter. We proceed to wrap the top portion of your stomach around your esophagus and suture that into place so it reinforces your esophageal sphincter. Once this is done, we check to make sure your wrap is not too tight with an endoscope, a flexible camera which can be passed through your mouth and into your stomach. We will then remove our laparoscopic instruments and close your incisions. Sometimes we will place a gastric tube during surgery, which is a tube between your stomach and your abdominal wall. This helps anchor the stomach to the abdominal wall to prevent the stomach from rising into the chest. It has the added bonus of being able to vent air and fluid from the stomach, which can help relieve discomfort if you are no longer able to belch or vomit. This tube is typically temporary, and will be removed at a later date once the track has formed. For certain medical conditions involving the esophagus, such as achalasia in which the esophageal sphincter does not relax like it is supposed to, a heller myotomy may be also be performed. This is a procedure in which we cut the esophageal sphincter muscle. Rarely, a larger abdominal wall incision may be necessary if the procedure cannot be completed safely through the smaller incisions. This is more common if you have previously had surgery in the area we will be working. In addition to your surgeon, an anesthesia provider, a surgical resident or surgical assistant, nurses, and surgical technicians will be present in the operating room. Since this is a teaching hospital, Medical students and other learners may also be present.