Laparoscopic Paraesophageal Hernia Repair
Douglas Cassidy, MD; David Rattner, MD
Massachusetts General Hospital
Surgical repair should be considered in all symptomatic paraesophageal hernias. Laparoscopic repair is considered the gold standard with a quicker recovery and lower morbidity and mortality compared to open repairs. The patient in this case presented with worsening dysphagia to solids and dyspnea in the setting of an enlarging paraesophageal hernia with a component of organoaxial volvulus. She underwent a laparoscopic paraesophageal hernia repair with a Toupet fundoplication and posterior gastropexy. The patient exhibited subjective improvement in her dysphagia to solids and dyspnea with exertion as well as an objective improvement in her pulmonary function tests postoperatively.
Laparoscopic Heller Myotomy and Partial Fundoplication for Achalasia
Marco Fisichella, MD, MBA, FACS
VA Boston Healthcare System
The gold standard for achalasia is surgical correction via laparoscopic Heller myotomy with a partial fundoplication. The goal of this technical report is to illustrate the authors preferred approach to patients with achalasia and to provide the reader with a detailed description of his operative technique, its rationale, and preoperative and postoperative management.
Robotic-Assisted Laparoscopic Paraesophageal Hiatal Hernia Repair with Fundoplication and Esophagogastroduodenoscopy
Hannah A. Bougleux Gomes, MD¹; Divyansh Agarwal, MD, PhD¹; Charu Paranjape¹’²
¹Massachusetts General Hospital/Brigham and Women’s Hospital
²Newton-Wellesley Hospital
A hiatal hernia occurs when part of an intra-abdominal organ, most commonly the stomach, migrates through the diaphragmatic crura. The condition can cause a range of uncomfortable symptoms, including heartburn, chest pain, and difficulty swallowing. While several individuals with a hiatal hernia can manage their symptoms with lifestyle changes and anti-reflux medications, some with refractory symptoms or complications secondary to the hernia require surgical treatment to repair the defect.
Here we present the case of a 60-year-old female with a paraoesophageal hiatal hernia and chronic gastrointestinal reflux disease (GERD) refractory to proton-pump inhibitors (PPI), dietary changes, and lifestyle modifications. She underwent an elective robotic hiatal hernia repair, fundoplication, and esophagogastroduodenoscopy (EGD) as a two-hour procedure with routine postprocedure recovery. This article and the associated video describe the pertinent history, evaluation, and operative steps of the procedure.
Laparoscopic Nissen Fundoplication
Ciro Andolfi, MD¹; Marco Fisichella, MD, MBA, FACS²
¹University of Chicago Pritzker School of Medicine
²VA Boston Healthcare System
This is the case of a 63-year-old man with a long-standing history of gastroesophageal reflux disease, refractory to medical management with high-dose proton pump inhibitors and H2-blockers. The preoperative workup consisted of: 1) an upper endoscopy, which was normal; 2) a barium swallow, which showed a normal anatomy (no hiatal hernia or diverticula); and 3) esophageal function tests, including high-resolution esophageal manometry, which showed normal peristalsis, and 24-hour pH monitoring, which confirmed the presence of gastroesophageal reflux disease.
Considering the amount of pathologic reflux, and the normal anatomy and esophageal peristalsis, it was decided to proceed with a laparoscopic Nissen (360°/total) fundoplication. The operation went well and lasted less than 90 minutes. The patient was discharged the following morning after resuming a light diet, and recovered quickly. With this surgical approach, complete control of reflux was achieved, and the patient was able to discontinue his treatment with proton pump inhibitors.
Laparoscopic Nissen Fundoplication
VA Boston Healthcare System
Marco Fisichella, MD, MBA, FACS
Assistant Professor of Surgery, Harvard Medical School
Associate Chief of Surgery, VA Boston Healthcare System
After medical management with high dose proton pump inhibitors proves to be refractory, a 63-year-old man with gastroesophageal reflux disease (GERD) presents for surgical management. Consequently, Dr. Marco Fisichella conducts a laparoscopic Nissen fundoplication.
Laparoscopic Paraesophageal Hernia Repair
David Rattner MD
Chief of Gastrointestinal and General Surgery
Massachusetts General Hospital
Dr. Rattner tackles a problematic paraesophageal hernia, systematically retracting the stomach into the abdominal cavity. He finishes the procedure by performing both a toupet fundoplication and gastropexy.
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