Transoral rotational esophagogastric fundoplication: technical, anatomical, and safety considerations

Background: Gastroesophageal reflux disease (GERD) results primarily from the loss of an effective antireflux barrier, which forms a mechanical barrier against the retrograde movement of gastric content. Restoration of the incompetent antireflux barrier is possible by longitudinal and rotational advancement of the gastric fundus about the lower esophagus, creating an esophagogastric fundoplication. This article describes the technique of performing a rotational and longitudinal esophagogastric fundoplication, performed transorally using EsophyX. Methods: The transoral incisionless fundoplication (TIF) technique enables the creation of a full-thickness esophagogastric fundoplication with fixation extending longitudinally up to 3.5 cm above the Z-line and rotationally more than 270 degrees around the esophagus. A key element of the technique involves rotating the fundus around the esophagus with a tissue mold during gastric desufflation. Anatomic considerations and use of the device's tissue invaginator to push the esophagus caudally are important to ensure safe positioning of the plications below the diaphragm. The steps of the technique are described in detail, and suggestions are given about patient selection and care, as well as prevention and management of complications. © 2010 The Author(s).SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Antireflux Transoral Incisionless Fundoplication Using EsophyX: 12-Month Results of a Prospective Multicenter Study

BACKGROUND: A novel transoral incisionless fundoplication (TIF) procedure using the EsophyX system with SerosaFuse fasteners was designed to reconstruct a full-thickness valve at the gastroesophageal junction through tailored delivery of multiple fasteners during a single-device insertion. The safety and efficacy of TIF for treating gastroesophageal reflux disease (GERD) were evaluated in a prospective multicenter trial. METHODS: Patients (n = 86) with chronic GERD treated with proton pump inhibitors (PPIs) were enrolled. Exclusion criteria included an irreducible hiatal hernia > 2 cm. RESULTS: The TIF procedure (n = 84) reduced all hiatal hernias (n = 49) and constructed valves measuring 4 cm (2-6 cm) and 230 degrees (160 degrees -300 degrees ). Serious adverse events consisted of two esophageal perforations upon device insertion and one case of postoperative intraluminal bleeding. Other adverse events were mild and transient. At 12 months, aggregate (n = 79) and stratified Hill grade I tight (n = 21) results showed 73% and 86% of patients with >or=50% improvement in GERD health-related quality of life (HRQL) scores, 85% discontinuation of daily PPI use, and 81% complete cessation of PPIs; 37% and 48% normalization of esophageal acid exposure; 60% and 89% hiatal hernia reduction; and 62% and 80% esophagitis reduction, respectively. More than 50% of patients with Hill grade I tight valves had a normalized cardia circumference. Resting pressure of the lower esophageal sphincter (LES) was improved significantly (p < 0.001), by 53%. EsophyX-TIF cured GERD in 56% of patients based on their symptom reduction and PPI discontinuation. CONCLUSION: The 12-month results showed that EsophyX-TIF was safe and effective in improving quality of life and for reducing symptoms, PPI use, hiatal hernia, and esophagitis, as well as increasing the LES resting pressure and normalizing esophageal pH and cardia circumference in chronic GERD patients.Journal ArticleMulticenter StudyResearch Support, Non-U.S. Gov'tinfo:eu-repo/semantics/publishe

La chirurgie anti-reflux: indication, principe et apport de la coelioscopie.

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Laparoscopic gastroplasty (adjustable silicone gastric banding)

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Multiport laparoscopic TME with low colorectal anastomosis

Rectal cancer surgery has to be performed with total mesorectal excision. Since the advent of minimally invasive surgery, nowadays, different techniques have been described. In this chapter the codified conventional laparoscopic technique with circular mechanical low colorectal anastomosis is described in step-by-step.SCOPUS: ch.binfo:eu-repo/semantics/publishe

Points clés et résultats de la cure coelioscopique du reflux gastro-oesophagien

SCOPUS: cp.jinfo:eu-repo/semantics/publishe

Contribution à la systématisation de la technique chirurgicale dans la fundoplicature selon Nissen par laparoscopie

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Robotic assistance: current available method and its evolution in visceral surgery.

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Contribution à la systématisation de la technique chirurgicale dans la fundoplicature selon Nissen par laparoscopie

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Developing robotic procedures: New technology and applications for medicine

SCOPUS: re.jinfo:eu-repo/semantics/publishe