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MainMINIMALLY INVASIVE PROCEDURESGeneral surgeryDiseases of esophagusRadiofrequency ablation (RFA)

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Laparoscopic fundoplication and radiofrequency ablation (RFA) in treatment of Barrett esophagus

Laparoscopic fundoplication and radiofrequency ablation (RFA) in treatment of Barrett esophagus.
Professor Puchkov K.V. is performing an operation (2018).

A 37 year-old male patient is operated on for Barrett esophagus (has been proved by the morphological method) on the background of hiatal hernia.

In this video the technique of endoscopic radiofrequency ablation (RFA) and laparoscopic partial (270 g) fundoplication according to Toupe in surgical treatment of Barrott esophagus on the background of axial hiatal hernia is demonstrated. At the first stage, after the morphological verification RFA has been performed, using self-setting balloon catheter (Barrx 360 Express RFA Medtronic Company), providing ablation area up to 3 cm and it gives a possibility to deliver point circular energy of RFA to the affected tissue of mucous membrane (endoscopic surgeon –Tishchenko E.S.).

In 2 months the second stage was performed-pathogeneric operation to prevent pathological reflux into esophagus-correction of hiatal hernia and fundoplication, using laparoscopy (Prof. Puchkov K.V. is performing an operation).Mobilization of gastroesophageal isthmus is performed by a 5 mm LigaSure MEDTRONIC-COVIDIEN instrument. The operation is performed fast and without blood loss. Attention is paid to the consecutive transection of esophageal-diaphragmatic and fundodiaphragmatic ligaments. Short gastric vessels are transected by LigaSure instrument, using inferior access, under the esophagus. A special attention is paid to careful cruroraphy. Then bilateral partial fundoplication according to Toupet is performed (270 g) with the help of interrupted intracorporeal suture. Operation duration is 40 minutes.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.

Endoscopic radiofrequency ablation (ERA) of Barrott esophagus

Endoscopic radiofrequency ablation (ERA) of Barrott esophagus.
D-r Tishchenko E.S., the Head of the Department, is performing an operation (2016).

A 27 year-old female patient is operated on for Barrett esophagus on the background of gastroesophageal reflux disease (GERD) without hiatal hernia. GERD has been proved by daily pH-metry and esophageal manometry, and Barrett esophagus-by morphological method. In this film diagnostic fibrogastroscopy (FGS) is presented, and biopsy of changes of mucous membrane of esophagus. After obtaining results of morphology radiofrequency ablation (RFA) of Barrott esophagus has been done. Self-set balloon catheter has been used (Barrx 360 Express RIA Medtronic company) that consists of bipolar electrodes that are in a soft balloon. This kind of positioning of active electrodes provides ablation zone up to 3 cm and gives a possibility to deliver circular energy of RFA to the affected tissue of the mucous membrane. The peculiarity of this kind of influence as compared to argon increased plasma is removal of only changed parts of the mucous membrane of esophagus, without injuring healthy parts and those parts that are located deeper. And it is not accompanied by stricture development in esophagus at the area of influence. After operation the therapy by proton pump inhibitors has been administered, under the dynamic guidance.

In 6 months after FGS Barrett esophagus has not been found out.

You can read about this technique in detail on the personal cite of Professor Puchkov Konstantin Viktorovich. To go to the link.

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