Technique
In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter. The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm.
In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way 360 degrees around the esophagus. In contrast, surgery for achalasia is generally accompanied by either a Dor or Toupet partial fundoplication, which is less likely than a Nissen wrap to aggravate the dysphagia that characterizes achalasia. In a Dor (anterior) fundoplication, the fundus is laid over the top of the esophagus; while in a Toupet (posterior) fundoplication, the fundus is wrapped around the back of the esophagus.
The procedure is now routinely performed laparoscopically and robotically using the da Vinci Surgical System. When used to alleviate gastroesophageal reflux symptoms in patients with delayed gastric emptying, it is frequently combined with modification of the pylorus via pyloromyotomy or pyloroplasty.
Read more about this topic: Nissen Fundoplication
Famous quotes containing the word technique:
“The audience is the most revered member of the theater. Without an audience there is no theater. Every technique learned by the actor, every curtain, every flat on the stage, every careful analysis by the director, every coordinated scene, is for the enjoyment of the audience. They are our guests, our evaluators, and the last spoke in the wheel which can then begin to roll. They make the performance meaningful.”
—Viola Spolin (b. 1911)
“I cannot think that espionage can be recommended as a technique for building an impressive civilisation. It’s a lout’s game.”
—Rebecca West (1892–1983)
“In love as in art, good technique helps.”
—Mason Cooley (b. 1927)