Laparoscopic Technique for Nissen fundoplication<\/i><\/p>\nSurgical Details of Nissen fundoplication Procedure<\/h4>\n
1. To start the Nissen fundoplication a 10 mm incision is made in the supraumbilical area.<\/p>\n
\n2. Dissection is done through the subcutaneous tissue with a combination of blunt dissection and Bovie cautery.<\/p>\n
3. The fascia is appreciated with retraction by Army-Navy retractors or S retractors.<\/p>\n
4. Stay sutures of 2-0 Vicryl are placed on either side of the midline and the fascia is incised.<\/p>\n
5. Forceps are used to grasp the peritoneum and a small incision is made to enter the abdomen.<\/p>\n
6. Finger palpation of the inside of the abdomen is performed to insure there are no adhesions.<\/p>\n
7. The Hasson cannula is placed into the abdomen with the stay sutures used to secure its position.<\/p>\n
8. Pneumoperitoneum with carbon dioxide is effected to a pressure of 15 mmHg.<\/p>\n
9. Under direct visualization after the videoscope is white-balanced, focused, and applied with antifog solution, a 10 mm port is placed bluntly in the left subcostal area.<\/p>\n
10. Under direct visualization, three 5 mm ports are placed in the epigastric, right abdominal, and left abdominal areas.<\/p>\n
11. A liver retractor (usually a fan-shaped retractor or loop-shaped retractor) in most Nissen fundoplication operations is introduced through the right abdominal port.<\/p>\n
12. The left lobe of the liver is retracted superiorly and laterally and the external portion is attached to the holding bracket on the operating table siderail.<\/p>\n
13. The greater curvature of the stomach is grasped with a endo Babcock retractor and the stomach is retracted anteriorly and to the right.<\/p>\n
14. The assistant grasps the lateral gastrosplenic ligament and retracts this and the spleen to the left.<\/p>\n
15. The gastrosplenic ligament is inspected and opened in an area away from the short gastric vessels.<\/p>\n
16. The harmonic scalpel is used to divide the short gastrics approximately 1 cm from the edge of the stomach to avoid injury to the stomach wall.<\/p>\n
17. To aid in visualization during Nissen fundoplication, the stomach is sequentially grasped beneath the just cut short gastrics.<\/p>\n
18. Dissection of the short gastrics is performed until the left crus of the diaphragm is visualized.<\/p>\n
<\/p>\n","protected":false},"excerpt":{"rendered":"
\nLaparoscopic Technique<\/i><\/p>\n
Surgical Details of Procedure<\/b><\/p>\n
1. A 10 mm incision is made in the supraumbilical area.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[22],"tags":[5805,1544,5803,5802,5804],"yoast_head":"\n