Laparoscopic Nissen Fundoplication: It’s Role in the Treatment of a Failed Esophyx Procedure

This is a 52 year old male, 9/11 responder who developed GERD and respiratory related issues from 9/11. He had a NDO plicator in 2006 with no effect, and an Esophex in November, 2008. This was complicated by abdominal pain, free air, and mediastinal air. He was treated conservatively and eventually responded over one week in hospital. However, the GERD increased markedly. He consented for a Nissen which was accomplished in June, 2009. At laparoscopy, the blue plastic pins where inserted through the esophagus, left crus of the diaphragm, and sometimes into the cardia of the stomach. Clearly, the hiatal hernia had not been reduced completely before the applications of the pins. This will be demonstrated in the video. The patient developed an abscess post operatively thought to be secondary to a sealed off perforation at one of the pin site. This is shown in the video. As IRcould not drain the abscess, laparoscopic drainage was performed. This is shown in the video as well. The dissection was surprising difficult because of the fixation of the pins to the esophagus, crus and stomach. The construction of the Nissen, while shown, is not the thrust of this video.

Session: Podium Video Presentation

Program Number: V038

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