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Laparoscopic Redo Nissen Fundoplication With Reduction Of Paraesophageal Hernia and Sliding Hiatal Hernia With Reconstruction of Esophageal Hiatus
Alexander S. Rosemurgy1; Kerry Thomas1; Desiree Villadolid1; Donald Thometz1; Sarah Cowgill1 ; 1. Surgery, University of South Florida, Tampa , FL ,

A five-trocar technique is used. The gastrohepatic omentum is opened and the dissection is carried up the right crus and into the mediastinum. The dissection includes division of the short gastric vessels. 8 cms of intraabdominal esophagus is ideal, so that the reconstructed valve mechanism lies well within the abdominal cavity. Bringing the left and right crura together behind the esophagus, the hiatus is reconstructed. The failed fundoplication should be augmented well above the GE junction. The existing fundoplication is not taken apart. The posterior fundus is attached to the esophagus and the right crus. Trocar sites are closed and dressings placed

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