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Laparo-Endoscopic Single Site (LESS) Hiatal Hernia Reduction with Nissen Fundoplication

Sharona B Ross, MD, FACS, Darrell J Downs, BS, Ty A Bowman, BS, Alexander S Rosemurgy, MD, FACS. Florida Hospital Tampa

This video demonstrates a Laparo-Endoscopic Single Site (LESSS) repair of a Hiatal Hernia with Nissen Fundoplication. Preoperative upper gastrointestinal study noted a small hiatal hernia and normal peristaltic activity of a barium-laden food bolus. Preoperative endoscopy confirmed a small hiatal hernia and retroflexion documented a loose gastroesophageal flap valve. Local anesthesia was applied at the umbilicus and a 0.8 cm vertical incision was made over an existing anatomical scar. A single multirocar SILS port was placed, pneumoperitoneum was established, and under videoscopic guidance, the liver was retracted. The gastrohepatic omentum was opened in stellate fashion and the dissection was carried to the right crus, up into the right crus, and into the mediastinum. The short gastric vessels were taken down and the dissection was carried to the left crus, up and down the left crus and into the mediastinum. The hernia was reduced in its entirety. 8cm of esophagus was brought to the peritoneal cavity. A polyester suture on a ski needle was utilized to bring the left and right crura together in a posterior cruroplasty. With a 54-French bougie per os introduced, the nissen fundoplication was constructed. The posterior fundus to the esophagus to the right crus so there would be no tension or twisting of the esophagus that would promote the wrap to come undone. Intraoperative EGD was undertaken which documented that the fundoplication was appropriately constructed at and above the GE junction. The diaphragm was irrigated with dilute bupivacaine solution to minimize postoperative pain. The umbilical defect was closed along anatomic layers and the skin was approximated with interrupted vicryl sutures and sterile dressing.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 80401

Program Number: V057

Presentation Session: Thursday Exhibit Hall Video Presentations Session 3 (Non CME)

Presentation Type: EHVideo

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