Laparoscopic Nissen Fundoplication for Reflux Esophagitis

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  • 逆流性食道炎に対する腹腔鏡下Nissen手術

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A 33-year-old male patient with reflux esophagitis has been successfully treated by laparoscopic Nissen fundoplication. He had associated heartburn for 3 years in spite of an internal treatment. The preoperative assessment including endoscopy, barium contrast studies, esophageal manometry, and 24h pH studies was performed.<br> The entire surgical procedure was performed laparoscopically. The patient was placed in a reverse Trendelenburg-lithotomy position and the operator stood between the legs. The left lateral segment of liver was retracted and the stomach was pulled downward to expose the operative field around the esophageal hiatus. The lower esophagus was dissected and fully mobilized. The short gastric vessels were divided to mobilize the gastric funds. After the funds and cardia were mobilized, the crura were approximated with two sutures of 2-0 nylon thread. The funds was pulled behind the esophagus. A 54 Fr bougie was introduced into the esophagus to prevent excessive narrowing. Interrupted sutures of 2-0 nylon thread biting through the funds, anterior wall of the esophagus and the gastric wrap were then placed. The 4 cm long gastric wrap was fixed by four stitches using extracorporeal knotting technique. The bougie was removed and a regular nasogastric tube was inserted.<br> The postoperative pain was negligible and symptoms of the patient disappeared postoperatively. He had a favorable postoperative course. Laparoscopic Nissen fundoplication can be a curative and minimally invasive surgery for the treatment of reflux esophagitis.

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