LAPAROSCOPIC OESOPHAGOFUNDOPLICATION TECHNIQUE Russian patent published in 2009 - IPC A61B17/94 

FIELD: medicine.

SUBSTANCE: invention concerns medicine, namely surgery, can be used in laparoscopic treatment of gastroesophageal reflux disease. Video laparoscopic aided diaphragm-oesophageal ligament is dissected. Right and left cruses of diaphragm are separated. It is followed with transhiatal dissection of oesophagus to be gripped with a handle. Retrooesophageal window is formed. Posterior gastric fundus is delivered through said opening. The delivered posterior gastric fundus is closed with anterior gastric fundus from the opposite side with fixing the formed fundoplication cuff at the level of abdominal oesophagus. A thick probe is preliminary inserted into lumen of oesophagus. Cruses of diaphragm are sutured with nonabsorbable suture material under oesophagus. Suturing is performed so that closed oesophageal hiatus opening in upper half is formed to provide free longitudinal relocation of oesophagus. In lower half hiatus opening shall be slit-like with its length exceeding width of the prospected fundoplication cuff. Then posterior gastric fundus with its free end is sutured to the left crus of diaphragm. Anterior gastric fundus is similarly fixed to the right crus of diaphragm. Thus the fundoplication cuff is formed without suturing gastric fundi ensuring free expansion of oesophagus within disjoin cuff while bolus passing and following origin return of tight closing of oesophagus walls.

EFFECT: method allows preventing postoperative dysphagia, providing antireflux mechanism of the cuff ensured by expansion of oesophagus inside of the cuff while bolus passing and soft closing thereafter, eliminating oesophagus compression with the cuff, preventing opening of cuff joints due to elimination of uncontrolled tension, allows preventing migration of oesophagus with the cuff owing to reliable and flexible fixation of the cuff, reducing injuries of tissues ensured by lower number of stitches as a result of fusion of fundoplication and hiatoplasty procedures, improving reliability of hiatoplasty owing to application of proper elastron.

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