Video of operations
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Relia Tack
Laparoscopic partial Toupet fundoplication (270 gr.) with recurrent HH after Nissen fundoplication with an additional prosthetic mesh implant
Автор: Puchkov K.V.
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.
Автор: Puchkov K.V.
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.
