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Video Based Assessment Collection Tool

Case Related Questions
Submitter Last Name*
Procedure Date*
Were any procedures performed in addition to a fundoplication? (select all that apply)
- Hiatal hernia repair <2cm
- Hiatal hernia repair >2cm
- Paraesophageal hernia repair
- Esophageal myotomy
- Esophageal lengthening procedure (e.g. Collis gastroplasty)
- Takedown of prior fundoplication (i.e. redo or revisional antireflux surgery)
- No additional procedures were performed
Do you know of any post-operative issues? (Select all that apply)
- Dysphagia > 3 months
- Persistent/Unresolved reflux
- Need for endoscopic intervention
- Need for surgical re-intervention
- Readmission related to the surgery
- No issues
- Unknown
What is the patient's BMI
- <25
- 25-29.9
- 30-34.9
- 35-39.9
- ≥40
Please rate your opinion of the performance of each of the following steps.
Below Average Average Above Average
Visualization of operative field
Hiatal dissection
Fundus mobilization
Esophageal mobilization
Hiatus repair
Wrap creation
Please note anything in this video that we should pay attention to. Portions that are particularly educational? Notable challenges? Etc.
Trainee Involvement Questions
Was a trainee involved?*
- Yes
- No
What level of supervision did the trainee have for the following steps of the procedure
Show and Tell Active Help Passive Help Supervision Only
Visualization of operative field
Hiatal dissection
Fundus mobilization
Esophageal mobilization
Hiatus repair
Wrap creation
See definitions of the Zwisch scale supervision levels.
Name
This field is for validation purposes and should be left unchanged.

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Email*
Email
This field is for validation purposes and should be left unchanged.

Important Links

SAGES 2018 Meeting Information

Our Advance Program is now available for download. Advance Program too big/too long? Download the Schedule at a Glance instead!

Online Registration is now available. . Please be sure to register before February 23, 2018 to obtain the early registration discount.

Healthy Sooner: Patient Information

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544