Surgical field — Laparoscopic view- Sliding Hiatal Hernia.
Sequence of images for Fundoplication -Achalasia
Completed 270-degree posterior hemifundoplication (Toupet fundoplication).
The fundoplication is sutured in place with a single U-stitch of 2–0 Prolene pledgeted on the outside. A 60-French mercury-weighted bougie is passed through the gastroesophageal junction prior to fixation of the wrap to assure a floppy fundoplication. Ins
A. Placement of Babcock clamp on the posterior fundus in preparation for passing it behind the esophagus to create the posterior or right lip of the fundoplication. To achieve the proper angle for passage, place the Babcock through the left lower trocar.
A. Three to six interrupted 0-gauge silk sutures are used to close the crura. B. Exposure of the crura and posterior aspect of the esophagus is facilitated by traction on a Penrose drain encircling the gastroesophageal junction.
Retract the stomach rightward and the spleen and omentum left and downward to complete mobilization of the fundus. These maneuvers open the lesser sac and facilitate division of the high short gastric vessels.