The anvil of the circular stapler
A. The anvil of the circular stapler is inserted in the proximal end of the bowel (which has been drawn out of the abdomen through an enlarged trocar site). B. The pursestring suture is tied. The bowel is then returned to the abdomen.
Closure of the Crural Opening
The crural opening is closed with simple, interrupted nonabsorbable suture (0 Ethibond). For large defects, pledgets and/or bioprosthetic mesh may be used.
Proper Orientation of the Fundic Wrap
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
Extracorporeal knot
Extracorporeal knot. Bring a long suture into the laparoscopic field, leaving its tail outside the port. Place the stitch; then bring the needle end out through the same port. Create a Roeder knot by tying an overhand knot and then wrapping the suture tai