Hiatal hernia

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 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.

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 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.

Laparoscopic resection of leiomyoma of esophagus and partial (270 g) fundoplication according to Toupet.

Laparoscopic resection of leiomyoma of esophagus and partial (270 g) fundoplication according to Toupet.
Professor Puchkov K.V. is performing an operation (2014).

In this film the technique of removal of leiomyoma of esophagus -7 cm- without opening the lumen of the organ is presented. Simultaneously correction of hiatal hernia (7 cm) by means of laparoscopic way is done. Mobilization of gastroesophageal isthmus is done with the help of 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 ligamemnts, as well as to fundodiaphragmatic ligaments, and to transection of short gastric vessels, using inferior access-beneath the esophagus. A special attention is paid to a careful cruroraphy and performing a partial fundoplication.

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

Laparoscopic partial (270 g) fundoplication according to Toupet.
Professor Puchkov K.V. is performing an operation (2012).

In this video the technique of correction of hiatal hernia (5 cm) laparoscopically is presented. Mobilization of the gastroesophageal isthmus is done with the help of a 5 mm Thunderbeat Olympus instrument, where the conception “one operation-one instrument” has been realized. The operation is performed fast and without blood loss. Attention should be paid to the consecutive transection of gastrodiaphragmatic and fundodiaphtragmatic ligaments, and transection of short gastric vessels, using inferior access (beneath the esophagus). A special attention is paid to a careful cruroraphy and performing of the partial fundoplication.

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