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Laparoscopic partial Toupet fundoplication (270 gr.) with recurrent HH after Nissen fundoplication with an additional prosthetic mesh implant

Laparoscopic partial Toupet fundoplication (270 gr.) with recurrent HH after Nissen fundoplication with an additional prosthetic mesh implant
Surgeon: professor K.V. Puchkov (2019).

The patient is 49 years old; a year ago he underwent laparoscopic Nissen fundoplication on HH. After 4 years there was a recurrence of the HH over the esophagus, the place of cruroraphy is wealthy.
The video shows a reoperation technique for relapsed HH by laparoscopic approach. Mobilization of the gastroesophageal junction is performed with a 5 mm monopolar electrode and LigaSure MEDTRONIC COVIDIEN instrument. There is marked adhesions in the area of operation. The Nissen cuff is untenable. Particular attention is paid to the careful separation of the esophagus and the upper part of the stomach from adhesions, the elimination of the fundoplication cuff. Surgery is carried out quickly and bloodless. Next step - the top cruroraphy and partial Toupet fundoplication (270 gr.). The line of stitches is strengthened with the help of additional prosthetics of this zone with a special 3D with the Parietex Composite mesh and its fixation according to the author's safe technique with a flexible Relia Tack MEDTRONIC COVIDIEN bend hernia stapler. Implant fixation is performed by absorbable takers. The duration of the operation is 1 hour and 40 minutes.

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

Laparoscopic partial (270 gr.) Toupet fundoplication with cruroraphy and mesh implant.

Laparoscopic partial (270 gr.) Toupet fundoplication with cruroraphy and mesh implant.
Surgeon: professor K.V. Puchkov (2019).

The video shows the technique of correction of the paraesophageal hernia of the diaphragm (5 cm) by the laparoscopic approach. Mobilization of the gastroesophageal junction is performed with 5 mm LigaSure MEDTRONIC COVIDIEN instrument. Surgery is carried out quickly and bloodless. Attention is paid to the sequential intersection of the esophageal - phrenic and fundal-phrenic ligaments. Short gastric vessels intersect with the LigaSure instrument, under the esophageal space. Particular attention is paid to thorough cruroraphy with additional prosthetics of this zone with a special mesh implant of the 3D grid Parietex Composite and its fixation according to the safe author's technique with a flexible Relia Tack MEDTRONIC COVIDIEN bend hernia stapler. The implant is fixed by absorbable tackers, at 4,6,9,11 hours along the inner edge of the mesh at an angle to the esophagus. The paper entry vector is perpendicular to the pedicle of the diaphragm and from the pericardium to the esophagus. At the final stage, a partial Toupet fundoplication is performed (270 gr.). The duration of the operation is 80 minutes.

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

Laparoscopic correction of diastasis recti and umbilical hernia, cholecystectomy

Laparoscopic correction of diastasis recti and umbilical hernia, cholecystectomy
Surgeon: professor K.V. Puchkov (2018).

Overweight patient. Gallbladder size 22 cm x 6 cm. Massive adhesions. The calculus size about 5.5 cm. Diastasis 18x5 cm, the size of the hernia gate is 4 cm. During the first stage, cholecystectomy is performed. Further, in the video it shows the technique of correction of diastasis recti and umbilical hernia by suturing them with the V-lock non-absorbable 2-0 thread (MEDTRONIC COVIDIEN) on an atraumatic needle. This stage is performed through trocars inserted for cholecystectomy. The final stage is the closure of the suture line with a ParietexComposite mesh (20x16 cm) and its fixation with transperitoneal sutures and a ProTack (MEDTRONIC COVIDIEN) hernia stapler. The duration of the whole simultaneous operation is 1 hour 30 minutes, the stage of correction of diastasis 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.

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.

Laparoscopic partial (270 g) fundoplication according to Toupet with the cruroraphy and mesh implant

Laparoscopic partial (270 g) fundoplication according to Toupet with the cruroraphy and mesh implant.
Professor Puchkov K.V. is performing an operation (2018).

In this video the technique of correction of axial hernia of esophageal orifice of diaphragm ( 6 cm), using laparoscopy, is presented. Mobilization of gastroesophageal isthmus is performed by a 5 mm LigaSure MEDTRONIC COVIDIEN instrument. The operation is performed fast and without blood loss. Attention should be paid to the consecutive transection of the diaphragmaticoesophageal ligaments and fundodiaphragmatic ligaments. Short gastric vessels are transected by LigaSure instrument, using inferior access, beneath the esophagus. A special attention should be paid to a careful cruroraphy with the additional prosthesis of this area by a special mesh implant 3D Mesh (Bard Davol Inc., U.S.A.). Implant fixation is carried out by a thread, along the circumference by 6 separate interrupted sutures, without using a herniostapler. At the final stage the partial fundoplication according to Toupet (270 g) is performed. Operation duration is 90 minutes.

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

Laparoscopic partial fundoplication according to Toupet (270 g) in case of relapse of hiatal hernia after fundoplication according to Nessen

Laparoscopic partial fundoplication according to Toupet (270 g) in case of relapse of hiatal hernia after fundoplication according to Nessen.
Professor Puchkov K.V. is performing an operation (2017).

A 44 year-old male patient was laparoscopically operated on a year ago for hiatal hernia, and fundoplication according to Nessen was performed. In a year a cuff slipped off, and configuration of esophagus and stomach was disturbed, i.e. malformation took place, a “small stomach” was formed, and stable heartburn developed, and he had the feeling of constantly full stomach. This video is presenting the technique of repeated operation in case of relapse of hiatal hernia, performed laparoscopically. Mobilization of gastroesophageal isthmus is done by a 5 mm monopolar electrode and LigaSure MEDTRONIC-COVIDIEN instrument. And cicatricial process at the operation area is clearly seen. Nissen’s cuff migrated 5 cm distally. A special attention is paid to a careful exposure of esophagus and superior part of the stomach, making free from adhesions, liquidation of fundoplication cuff. Operation is performed fast and without blood loss. The cruroraphy is performed and partial fundoplication according to Toupet (270 g). Operation duration is 80 minutes.

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

Simultaneous laparoscopic partial resection of stomach and fundoplication with cruroraphy

Simultaneous laparoscopic partial resection of stomach and fundoplication with cruroraphy.

Laparoscopic stage - Professor Puchkov K.V. is performing an operation (2017), endoscopic diagnostics- D-r Tishchenko E.S. is performing.
Operation is performed for leiomyoma of the antral part of the stomach (2.5 cm at the distance of 3 cm from the pyloric part) and for hiatal hernia. In the video intraoperation gastroscopy is presented, with the marking of the resection area, then the technique of dissection of the area of the greater curvature of stomach by a 5 mm LigaSure MEDTRONIC COVIDIEN instrument is presented, as well. At the next stage resection of the stomach part is done by the linear stitching Endo GIA MEDTRONIC COVIDIEN apparatus in the transverse direction under the guidance of gastroscopy. .The preparation is placed into the plastic container and is removed from the abdominal cavity. Then mobilization of gastroesophageal isthmus is done by a 5 mm LigaSure instrument, then cruroraphy and bylateral partial fundoplication according to Toupet (270 g) with the help of interrupted intracorporeal sutures is performed. Operation duration is 1 hour 20 minutes.

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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