Cruroraphy

Sleeve gastrectomy, hiatal hernia, reconstruction of esophageal-diaphragmatic membrane

Sleeve gastrectomy, hiatal hernia, reconstruction of esophageal-diaphragmatic membrane.
D-r Evdoshenko V.V. and D-r Fedenko V.V. are performing an operation.

While performing an operation for sleeve gasterectomy, it has been found out that a patient has hiatal hernia. It is known that sleeve gasterectomy can promote development of hiatal hernia in 30-50 % of cases. So, an operation for hiatal hernia is compulsory when you are performing an operation for sleeve gasterectomy. Thus, cruroraphy has been performed, as well as reconstruction of esophageal-diaphragmatic membrane as a kind of circular esophagophrenopexy.

Laparoscopic nervepreserving resection of epifrenal esophageal diverticulum with cruroraphy.

Laparoscopic nervepreserving resection of epifrenal esophageal diverticulum with cruroraphy.
Professor Puchkov K.V. is performing an operation (2016).

Operation is performed for epifrenal diverticulum -4 cm- located at the distance of 8 cm from cardium. In this video the technique of dissection of gastroesophageal isthmus and exposure of diverticulum out of surrounding tissues by means of a 5 mm Ligasure MEDTRONIC COVIDIEN instrument and instruments of Karl Storz Company is presented. Attention should be paid to the preliminary exposure of the right diaphragmal nerve. Diverticulum dissection is done without opening of the pleural cavity. Then, under the guidance of esophagoscopy, the diverticulum is dissected in the transverse direction by means of a linear stitching Endo GIA MEDTRONIC COVIDIEN apparatus with cassette length 60 mm and Tri-Staple technique. This technique provides the consecutive closure of staplers at the expanded spectrum of tissues of different thickness, it gives a possibility to perform hemostasis in the area of stitching and not to press tissues hard while stitching them. Then cruroraphy is performed, and the normal anatomy of the cardial area is restored. 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.