LAPAROSCOPIC TOUPET FUNDOPLICATION WITH BILATERAL RUNNING SUTURES

The gastrohepatic ligament is opened. The right diaphragmatic crus is dissected free. Dissection of the crura automatically result in a tunnel behind the esophagus. The posterior part of the left crus is now nicely exposed. A penrose drain is passed behind around the esophagus, incorporating both the anterior and posterior vagus nerves. The esophagus is pulled upward, and dissection is carried out in the posterior mediastinum. The lower 5 cm of the esophagus should stay in the abdominal cavity without any tension. Short gastric vessels are then divided. A posterior hiatoplasty is performed using three resorbable prolene 2-0. A space of about 1 cm is left between stitches. The fundus is pulled behind the esophagus to the right side. Tailoring of the wrap is controlled by the shoeshine test. The upper left part of the fundus is fixed with the left crus and the esophagus. Similarly another suture fixes the upper part of the wrap to the right side of the esophagus. A single suture fixes the lower right and left part of the fundus to the esophagus. A running PDS 3-0 suture is used bilaterally to reinforce the wrap within the esophagus.