Sharona B Ross, MD, FACS, Janelle D Spence, BA, Iswanto Sucandy, MD, Alexander S Rosemurgy, MD, FACS. Florida Hospital Tampa
Introduction: This is robotic reoperative giant hiatal hernia repair with loose Nissen fundoplication undertaken in a 75-year-old gentleman presented to the emergency department with epigastric pain, profound dysphagia, and a loss of appetite.
Methods and Procedures: Monemetry documented esophageal dysmotility and a CT scan corroborate the existence of the giant hiatal hernia.
Results: The operation was undertaken utilizing 6 ports, pneumoperitoneum was established, and under laparoscopic guidance, the liver was retracted. More than a half to three-quarters of the stomach was placed in the mediastinum. Carefully the dissection began toward the right crus into the mediastinum and slowly reduced the stomach back into the abdomen. Soon after, attention was turned to the short gastric vessels. Ultimately, the entire hiatal hernia was replaced into the peritoneal cavity and the hernia sac was divided and removed. 6-7 cm of esophagus was brought to the peritoneal cavity during mobilization. Reconstruction of the esophageal hiatus was undertaken using an Endo Stitch device with a V-Loc suture. The reconstruction was augmented by placing a suture on the ventral aspect of the defect to ensure a secure reconstruction that was tight, yet not too snug.
Conclusions: After the reconstruction was completed, the considerations for the fundoplication were made. The posterior fundus was sutured to the ventral and left side of the esophagus and then the anterior fundus was sutured to the ventral and right side of the esophagus. The posterior fundus was sutured to the ventral and left side of the esophagus and then the anterior fundus was sutured to the ventral and right side of the esophagus. Intraoperative EGD was undertaken which documented that the Nissen fundoplication was appropriately constructed at and above the GE junction. The posterior fundoplication was anchored to the esophagus and right crus and the anterior fundoplication was anchored to the left crus. The diaphragm was irrigated with dilute bupivacaine solution to minimize postoperative pain. The skin was approximated with interrupted vicryl sutures and sterile dressing. The patient tolerated the operation well with an uneventful postoperative course and was discharged the next morning.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95950
Program Number: V385
Presentation Session: Video Loop Day 4
Presentation Type: VideoLoop