Case 118: Reflux operation
This is an image taken during a laparoscopic anti-reflux procedure. The view is looking towards the hiatus, with the divided lesser omentum to the left of the picture, revealing the caudate lobe of the liver. The left hepatic lobe is elevated with the Nathensen liver retractor.
1. What type of anti-reflux procedure has been performed?
The reflux procedure is a 180 degree anterior fundoplication (the anterior wrap).The light blue Ethibond sutures have been used to secure the fundus of the stomach to the right pillar (the right Crus of the diaphragm) and then to the superior margin of the hiatus (the phreno-oesophageal ligament and the diaphragm itself). The sutures on the right side of the photo, and those just out of view, are reconstructing the 'angle of His' by approximating the proximal fundus/cardia of the stomach to the left side of the hiatus.
References:
RCSED - Anterior fundoplication - how to do it
Watson DI, et al Prospective randomised double-blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 1999
Case Editor:
Mr Tom Sweeney - General and Upper GI surgeon. The Northern Hospital