Antireflux Procedures

Abstract

In the last decade, a new philosophy to be less invasive in minimally invasive surgery and to perform laparoscopy without visible scars invested surgeons, researchers and companies. The purpose was basically the improved cosmesis, but the postoperative pain, the hospital stay, and the patient’s convalescence were also attempted to be reduced.

Natural orifices transluminal endoscopic surgery (NOTES) and single-port/single-incision laparoscopy (SPL/SLS) were the two principal fields of researches and investments. Due to the difficulties to perform the conventional multiport laparoscopic procedures through NOTES and sometimes also through SPL/SLS, a new philosophy to keeping in mind the desire of less invesivity of minimally invasive surgery started to be popular and named reduced port laparoscopic surgery (RPLS). In RPLS, the classic multiport laparoscopic procedures can be performed in a similar method, but through a reduced number of trocars, a reduced size of each trocar and use of needlescopic instruments. Furthermore, some intrabdominal devices can be inserted in the abdomen and used like an assistant’s help or to improve the operative field’s exposure.

In this chapter two main antireflux procedures, Nissen fundoplication (360°) and Toupet fundoplication (270°), are described step by step using the transumbilical access, and curved reusable instruments. Each step is represented by specific drawings showing the internal triangulation, which characterizes the conventional multiport laparoscopy, and the external surgeon’s ergonomy.