I02 t

Mlnimol Access Procedures Surgicol Procedures lncluding

Gostrointestinot Surgsry

o le$

HERNIORRHAPTIY . ESOPHAGEAT HIATAT

Preporotion of the potienf, Skin

Defrnition

Repair of the esoph?ifft SflXtl"t-#;1il"?fl:*X1" plJu""t herniation of t

Diicussion who are

ffi l"fl:lr:i 3t: Bis i,,3Hrg;"'

See Vagotomy and pyloroplasty, pp. 106_10g.

is often detected in patients Esophageal hiatal hernia repair tgl

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correct

Definition
_En1{y_sconic

asvmptomat;''iJ;;i;"" -t^11*:,t^l #i,,;e .r#;';'r .' ::i"*;il"1,1n-ff.ffi :iltT3ili. ma-nom emic n nd tKliitXXt ffi t.'Hh occasron' dt'ii"ei' "" aherniation of the lppu"""t ings. On 'il ir a.t" to a foreshortstomach into the.nor.ii.*JJ"ily have been deened esophas""' N;:;;;p"Jtta"t""

wrapping of the gastric fundus about the ga stroesopha

ge"l

;;il;;

d/"r

hi

tal

flbcussion

;i";-;;'.";e"t*,i'"'"cliil*""9,,::11.ff1"1;$, transthoracic' or latr single procedure has rence rate is relativefi t#;-*;
t"""
aut"t*ined to be best'
Procedure

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lais procedure is used to treat gastroesophageal reflux Osease and certain nrr
and

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hcedure

"

u""'i""

to

"X'i":;f,l",?:Xlli: i,,;;,h'";;;. gastric

de:cribed' A transabdominal approu:|. *ili-}"^

The

heumoperitoneum

is

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"

""f,ii. lization""of

dl*5 the.left

ll ;l'l ",',":"": tl'Ji!i#*; Ln^i'i*ti""f

nonabsorbable suthe distal esophagus' The to reflected portions

r..orr'o.li^^*^_. ., ,,

'lffi

are exPosed and, I

iorly, approxi-"t"i'ittt"airJ potiJ"iii tl ture) inferior ""o ;;;;;;"i"t"a distal esopha*"t

t*ftf+:=t*l':;t-*lilru witn

rsif t-""1?t?il:i{,:"ff niru* jli ffiT$"f vegal nerve branche; ir"pi"i;:iT:*,l: y^and
I"tff;'""t*t":?l^'1.""1':t"J"'*r;;"i#"L*r' a drain.or soft catheter 1e.f:"#:;i;T""i*t" g1lion, 9l tr," l"#:':*: ".Jph"su;. fi ;#_ ,?li{f {""},':ri$l**::1',t#:f,**fi :#; H"q"f i,li:'."JiTrT :r fli:: J,1il:_tlifilili:Ttr transorally.
The gastric :::. F:1.f,':* f9rceg9 passgd p".t""i""ii"tf,i agus. An adjacent oo"tio" ror to the esophagus and apposed t,l a.n"^o".ri"i_

gH'*n:miry;lJ::::.:;*
"""

H;;* :f",*x?*,'.':}iii":.:l'fi i,' i :i' ry! a: etracted, and incising of the lrij1ift

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ii-til"p",itoo-".,*f**lf*r_:1,-;t,t11Tf maki"e th" I"nt:t'""-i::'a:fi"'l';;;i;uen tlo avoid nerves' The vagus pair too tight ano io;;l"ti; the a,large-diameter ti pu'"t anesthetist *"v o""utii"a that the hiatus is not

il#

:ffiffi;;i

u""gi"'il a"i;;-i""^

,t"i"tv .otPromised'

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