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Situs Ambiguus, understanding the challenges for Nissen fundoplication

Carlos Chavez De Paz, MD, Juan C Quispe, MD, Maher Musleh, MD, Crystal Alvarez, DO, Aarthy Kannappan, MD, Panisha Kittipha, MSN, Daniel Srikureja, MD, Jeffrey Quigley, DO, Keith Scharf, DO, Esther Wu, MD, Marcos Michelotti, MD. Loma Linda University Health

The patient is a 47-year-old female with the diagnosis of situs ambiguus and a hiatal hernia, associated with Barrett's esophagus. She was evaluated for symptoms of refractory acid reflux and regurgitation. On the last two years, she underwent multiple esophagogastroduodenoscopies with HALO-90® radiofrequency ablation of the distal third of the esophagus. The patient had and attempted Nissen procedure at another institution, which was aborted due to technical difficulties. She was referred to our institution for higher level of care.

After appropriate workup and review of imaging, the patient underwent a robotic-assisted repair of the hiatal hernia with bio-absorbable mesh and Nissen fundoplication. The surgery was carefully planned and the robot was docked with the ports in a mirror-like way than for a conventional case. The technical challenges of operating with a right sided stomach and a midline liver are described. The hernia was reduced with the mesh placed as well as the fundoplication was done without complications. Her post-operative course was uneventful, she was discharged on a blenderized diet. Eight weeks after surgery she was eating a regular diet, denied any symptoms of reflux and had stopped taking anti-acid medications.


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

Abstract ID: 95917

Program Number: V210

Presentation Session: Video Loop Day 1

Presentation Type: VideoLoop

84

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