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Nissen type laparoscopic funduplication is a surgical procedure used to treat chronic gastroesophageal reflux. It consists of wrapping the upper part of the stomach around the bottom of the esophagus, thus creating an anti-reflux valve. This technique has been shown to be effective in relieving symptoms and improving the quality of life of patients who do not respond to medical treatment. This guide presents a detailed description of the procedure and discusses its advantages and disadvantages.
Nissen-type funduplicature is a surgery to correct gastroesophageal reflux disease. In this procedure, the surgeon wraps a portion of the stomach around the lower part of the esophagus, strengthening the lower esophageal sphincter and thus preventing the reflux of stomach acids into the esofagus. This technique has been used for many years and is considered the gold standard for the surgical treatment of chronic gastroesophageal reflux. This section provides a more detailed definition of Nissen-type funduplication and explains its objectives and benefits.
The laparoscopic pathway is of vital importance in the realization of Nissen-type funduplication, as it offers numerous benefits compared to open-air surgery. This minimally invasive approach uses small incisions instead of a large incision, which reduces postoperative pain, speeds up recovery, and reduces the risk of complications. In addition, laparoscopy provides a magnified view of the internal anatomy, allowing the surgeon to perform precise sutures and ensure a good fixation of the stomach to the esophagus. In this section, the importance of the laparoscopic pathway in the Nissen type funduplicature will be highlighted and its advantages explained in detail.
The laparoscopic Nissen-type funduplicature surgery is an intervention used to correct gastroesophageal reflux. This technique involves wrapping the upper part of the stomach around the esophagus, creating a kind of “manga” that helps prevent the passage of stomach acid into the esofagus. The surgery is performed using high-definition images and small incisions are inserted into the abdomen to insert the surgical instruments. This procedure has been shown to be effective in the long-term treatment of reflux and can significantly improve the quality of life of patients.
Before undergoing a laparoscopic Nissen-type funduplication, it is important that the patient undergoes a comprehensive evaluation to determine his or her suitability for surgery. This may include tests such as endoscopies, X-rays, and blood tests. In addition, the patient should receive detailed information about the procedure, including the associated risks and benefits. During preparation, the patient may be asked to follow a special diet and to discontinue certain medications before surgery. You may also be asked to undergo intestinal cleansing to ensure an empty colon before the procedure.
Nissen-type laparoscopic funduplication is performed under general anesthesia, which means that the patient will be completely asleep during the procedure. Once the patient is anesthetized, it is placed in a supine decubito position, that is, mouth up, with arms extended and secured to allow adequate access to the abdomen. Measures are taken to ensure the patient’s comfort and safety throughout the procedure, including placing pillows under the legs to prevent slipping and applying a urinary probe to control the removal of liquids during surgery.
Laparoscopic access in the Nissen type funduplicature involves the insertion of a laparoscopy chamber and various surgical instruments through small incisions in the abdomen. These incisions are usually approximately 0.5 to 1 cm in length. Carbon dioxide is used to infuse the abdomen and create a working space, allowing clear visualization and adequate access to the abdominal structures. The camera is inserted through one of the incisions and the other incisors are used to guide and manipulate instruments during the procedure. Laparoscopic surgery offers advantages such as shorter recovery time and lower risk of complications compared to open air surgery.
The realization of the Nissen type funduplication by laparoscopic means different steps. First, adhesions between the stomach and other abdominal structures are identified and released. Then, the upper part of the stomach is isolated, creating a hose around the esophagus. The gastric folds are suturated to fix the “manguito” in its position. Subsequently, the correct placement of the funduplicature is checked and the incisions in the abdomen are closed. Thro the procedure, suture and ligature techniques are used to ensure a safe and lasting connection between the esophagus and the stomach. This technique has been shown to be effective in reducing the symptoms of gastroesophageal reflux and in improving the quality of life of patients.
The Nissen type laparoscopic funduplication has both advantages and disadvantages. These should be taken into account when evaluating the choice of this technique. It is important to note that advantages can outweigh disadvantages in many cases, depending on the specific needs and characteristics of each patient.
Among the advantages of the Nissen type laparoscopic funduplicature is less invasion when performing surgery, which implies less need for incisions compared to open surgery. This results in faster recovery, less postoperative pain and shorter hospitalization. In addition, laparoscopic surgery provides a better visualization of the internal organs through the use of a camera, which allows for greater accuracy in the execution of the funduplicature.
Despite its many advantages, the Nissen type laparoscopic funduplication also has some disadvantages. An important disadvantage is the need for greater skill and experience on the part of the surgeon, as the laparoscopic procedure requires technical skill in maneuvering instruments through small incisions. In addition, in some cases, there may be an increased risk of laparoscopic surgery-related complications, such as injury to nearby organs or incisional hernia. However, these risks are uncommon and are usually associated with the lack of experience of the surgeon or the existence of pre-existing medical conditions of the patient.
Nissen-type laparoscopic funduplication has proven to be an effective procedure for the treatment of gastroesophageal reflux disease. Short-term results show a significant reduction in reflux symptoms, such as heartburn and regurgitation. In addition, there is an improvement in the quality of life of the patients, by being able to enjoy meals without experiencing discomfort. However, in the long term, some cases of recurrence of symptoms may occur, which may require a review of the procedure. On the other hand, it is important to highlight that there are possible complications associated with this surgery, such as dysphagia, forgotten gas syndrome and recurring hiatal hernia. These complications can be prevented by careful surgical technique, proper postoperative follow-up and proper management of risk factors during surgery.
The short-term results of laparoscopic Nissen-type funduplication are encouraging. Significant improvement is observed in gastroesophageal reflux symptoms, such as stomach acidity and regurgitation. Patients report a decrease in the frequency and intensity of these discomforts, which allows them to have a better quality of life. In addition, most patients can resume their regular diet without experiencing discomfort, which improves their overall well-being. However, it is important to highlight that results may vary from patient to patient and that adequate follow-up is required to evaluate long-term effectiveness.
The long-term results of laparoscopic Nissen-type funduplication are generally positive. Most patients experience lasting improvement in gastroesophageal reflux symptoms, allowing them to lead a life free of refluxe-related discomfort. This surgery has been shown to significantly reduce the need for medications for the treatment of reflux, which is an additional benefit to patients. However, in some cases, recurrence of reflux symptoms may occur, which may require a revision of the procedure. It is important to emphasize that long-term monitoring is crucial to assessing long-run effectiveness and detecting any complications.
Nissen-type laparoscopic funduplication, like any surgical procedure, may present possible complications. Some of the complications that may occur include dysphagia (difficulty in swallowing), forgotten gas syndrome, and recurring hiatal hernia. These complications can be prevented by careful surgical technique that avoids damage to esophageal structures and proper placement of the sutures during the funduplication. In addition, proper postoperative follow-up is essential to detect and treat any early complications. It is also important for patients to follow postoperative recommendations, such as avoiding lifting heavy objects andining an adequate diet, to minimize the risk of complications. In general, the risk of complications is low, but it is essential that patients are aware of them and follow the instructions of the medical team to prevent them.