LAPAROSCOPIC NISSEN FUNDOPLICATION

LAPAROSCOPIC NISSEN FUNDOPLICATION

     Laparoscopic nisses fundoplication 



Laparoscopic nissen fundoplication is a minimally invasive procedure which is done to restore the function of lower esophageal sphincter this is the valve present between the esophagus and stomach which is also called hiatal hernia.In this procedure the fundus or upper part of the stomach is wrapped around the lower portion of the esophagus and fundoplication is formed by suturing the stomach around the esophagus.  

Hiatal hernia is an opening in the diaphragm through which stomach or omentum is forced into the chest cavity and some time small intestine also stuck into the chest cavity. 

Type 1 hiatal hernia repair is usually by laparoscopic nissen fundoplication. 
Indication and symptoms of the hiatal hernia severe heartburn, severe inflammation of the esophagus due to reflux, esophageal strictures due to acid damage, chronic inflammation of the lungs (pneumonia ), regurgitation, dysphagia(difficulty in swallowing )

In this procedure patient keep on trendelenberg position, first of all surgeon  fill  abdomen with carbon dioxide gas through veris neddle and some surgeons use hasan technique by blunt trocar  after the creating pneumoperitoneum surgeon introduced another remaining port under visualization surgeon makes five port one is for 10mm telescope (Laparoscope) and another two is for working port, fourth port is four nathanson retractor for liver retraction and last is for extra port for other hands.

After that surgeon assess esophagus through the incisions and carry out whole procedure with a video camera and specialized instruments and mobilize the esophagus. 

Surgeon grabbing the upper part of your stomach (fundus) and wrap it around the lower end of your esophagus and secure the stomach tissue around esophagus by surgical sutures.

Complications after the surgery :

Bleeding at the surgical site

Difficulty swallowing (dysphagia) because your stomach is wrapped too high on your esophagus or wrapped too tightly

Difficulty belching

Infection in your abdomen (peritonitis)

slipping of the wrapped portion of your stomach, meaning your lower esophageal sphincter is no longer supported

 perforation or tearing in the lining of your esophagus

After the discharge from the hospital :
If patient experience following 
symptoms or problems then immediately contact the doctor:
-Severe persistent pain not relief by medication and rest.
-Difficulty obtaining medication any new onset of or increased weaknesses numbness or tingling.
-Persistent chills new onset of fever over 101° degree farehnit or night sweat.
-Any redness, swelling drainage, heat or pain around incision. 
-Any new onset of chestpain or shortness of breathing. 
-Any clogging or dislodgement of surgical drain.

Some changes can help control some symptoms of hiatal hernia:

1. Maintain a healthy weight
2. Stop smoking
3. Eat at least 2 to 3 hours before bedtime.
4. Avoid lying down after a meal or eating late in the day
5. Eat several smaller meals throughout the day rather than a few large meals
6. Avoid foods like chocolate, mint, garlic, caffeine, onion, fried foods, etc. that trigger heartburn

Image source: google 

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