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FUNDOPLASTY

REASON FOR VISIT:

• Esophagitis
• Hiatus hernia
• Gastro esophageal reflux
• Heart burn
• Regurgitation

RISK ASSESSMENT

• Old age
• Prior heart diseases
• kidney diseases
• Diabetes
• Hypertension
• History of bleeding disorders
• Taking aspirin and other anticoagulants
• History of allergy to medications
• History of allergy to anesthesia

PREPARATION OF THE PATIENT

• Blood tests
• Urine tests
• Chest x-ray
• Barium x-ray
• EKG/ECG
• Endoscopy
• Patient was on fasting for ____hrs before the procedure
• Enema was given
• Aspirin and other blood-thinning medications were stopped for
several days before the surgery
• Preoperative antibiotics were administered to the patients with
diseases of the heart valves
• Part was prepared and draped in sterile fashion

ANESTHESIA:

General anesthesia

POSITION OF THE PATIENT

Supine position

THE PROCEDURE

Methods

• Open surgery
• Laparoscopic surgery

OPEN SURGERY

• An external incision given in the lower part of chest and upper


part of the abdomen of the patient ________cm.
• abdomen is opened in layers
• The gastrohepatic and phrenoesophageal ligaments were divided
to exposing the GE junction.
• The stomach was freed from its attachment to the spleen.
• The right crura had been dissected free, and the esophagus was
recognized.
• The portion of the esophagus in the abdomen was freed of its
attachments.
• An arterial vessel was divided between clips to allow better
mobilization of the stomach
• The upper region of the stomach was wrapped around the lower
esophageal sphincter to increase pressure on the lower
esophageal sphincter
• The wrapped portion was then sewn into place so that the lower
part of the esophagus passes through a small hole in the
stomach muscle.
• A large rubber dilator was placed inside the esophagus to reduce
the overly tight wrap.
• Hiatus hernia was repaired
• Abdomen was sutured in layers

LAPAROSCOPIC SURGERY

• Several small incisions are created in the abdomen.


• The laparoscope was then passed into the abdomen through one
of the incisions.
• The other instruments were passed into the abdomen through
other incisions
• The abdomen was inflated with carbon dioxide.
• The contents of the abdomen can now be viewed on a video
monitor that receives its picture from the laparoscopic camera.
• The gastrohepatic and phrenoesophageal ligaments were divided
to exposing the GE junction.
• The stomach was freed from its attachment to the spleen.
• The right crura were dissected free, and the esophagus is being
recognized.
• The portion of the esophagus in the abdomen was freed from its
attachments.
• An esophageal dilator was then passed through the mouth into
the esophagus. This dilator keeps the stomach from being
wrapped too tightly around the esophagus.
• The portion of the esophagus in the abdomen was freed from its
attachments.
• The top portion of the stomach (the fundus) was passed behind
the esophagus, wrapped around it 360°, and sutured in place.
• If a hiatus hernia was present, the hiatus (the hole in the
diaphragm through which the esophagus passes) was made
smaller with one to three sutures so that it fits around the
esophagus snugly.
• The sutures keep the fundoplication from protruding into the
chest cavity.
• The laparoscope and instruments were removed
• The skin incisions were closed in layers by sutures
• Dressing was done

AFTER PROCEDURE:

• Immediately after surgery the patient was taken to a recovery


area
• The blood pressure/pulse/temperature was monitored
• Nothing is taken for _____hr

DURATION

________minutes

POSTOPERATIVE CARE

• Take antibiotic treatment as prescribed


• Take pain medications prescribed
• Observe for in discharge from suture site
• Surgical wound dressings will be kept clean and dry
• Take liquid diet for _____days

COMPLICATIONS

• Heartburn recurrence
• Swallowing difficulties caused by an overly tight wrap of the
stomach on the esophagus
• Failure of the wrap to stay in place so that the LES is no longer
supported
• Normal risks associated with major surgical procedures and the
use of general anesthesia
• Increased bloating and discomfort due to a decreased ability to
expel excess gas
• Infection
• Breathing difficulties and pneumonia
• Adverse reactions to anesthesia