Horizontal Mattress Suture for Diaphragmatic Crura Closure in Laparoscopic Antirreflux Surgical Procedures.

Jose Daniel Lozada Leon, MD

Sanatorio Santa Monica, Cuernavaca., Morelos, Mexico.

The aim of this video is to present the technique of closure of the diaphragmatic crura with horizontal mattress suture.

There is still controversy regarding the benefits offered by the diaphragmatic crura plasty with prosthetic material in patients with giant hiatal defects, however, in elderly patients with low physical activity is feasible to close the diaphragmatic crura with U stich suture or horizontal mattress suture because it increases the contact surface between the pillars crura, thus promoting the post-op healing process, giving a very secure seal.

In a period time of two years we performed 20 surgical anti-reflux surgical procedure with this technique in a group of patients with range aged of 65 to 77 years old, 12 (60%) males and 8 (40%) females with a mean of 71 years, 3(15%) patients with esophagitis grade D, 7 patients with esophagitis grade C (35%) and 10 patients esophagitis grade B(50%), 4 patients with Barrett’s esophagus were male, 13, (65%) patients underwent posterior partial fundoplication, 7(35%) patients floppy nissen fundoplication, 12 patients underwent esophageal manometry test and 24 hours pH monitoring with impedance test.

The procedure was completed in 100% of patients, operative time averaged 58 minutes, 12(60%) patients were discharged hospital within 24 hrs, 6 (30%) patients in 48 hrs and 2( 10%) patients at 72 hrs, post-operative dysphagia were reported in 3(15%) patients that improved three months later and 1(5%) patient with permanent dysphagia , there was no other morbidity and mortality in this series, we have follow up 16 (80%)patients post- operated with this technique, in 8(40%) patients we performed postoperative upper GI endoscopy one year after the anti-reflux surgical procedure with the fundoplication wrap in situ and 19(95%) patients referred good quality of life measured with visick scale.

We believe that this technique provides good results in this group of patients, is less expensive and without the complications that provide patients with prosthetic material.

Session: Poster Presentation

Program Number: P265

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