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イワモト タカユキ
Takayuki Iwamoto
岩本 高行 所属 川崎医科大学 医学部 臨床医学 乳腺甲状腺外科学 職種 講師 |
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| 論文種別 | 総説 |
| 言語種別 | 英語 |
| 査読の有無 | 査読あり |
| 表題 | Laparoscopic tailored Nissen fundoplication. |
| 掲載誌名 | 正式名：Surgical endoscopy 略 称：Surg Endosc ISSNコード：14322218/09302794 |
| 掲載区分 | 国外 |
| 巻・号・頁 | 24(9),pp.2221-5 |
| 著者・共著者 | Hitoshi Idani, Shinya Asami, Takashi Ishikawa, Shinichiro Kubo, Takayuki Iwamoto, Shinichiro Watanabe, Hitoshi Kin |
| 発行年月 | 2010/09 |
| 概要 | BACKGROUND:It is difficult sometimes to determine the suture points for proper Nissen fundoplication under laparoscopy. We introduce a new procedure to define the suture points in Laparoscopic Nissen fundoplication (LNF).SURGICAL TECHNIQUE:After dissection of the hiatus and mobilization of the fundus, the circumference of the esophagus c is measured at a point 2-cm cranial from the esophagogastric junction over the 52-Fr bougie. The inner diameter of the fundoplication is calculated based on the esophageal diameter. To create a 2-cm fundoplication in which the greater curvature of the gastric fundus is moved straight toward the cranial side without any twist, we located points a and b, which correspond to the top of the left and right suture positions on fundoplication, respectively. Approximately 2 cm of floppy Nissen is constructed by suturing caudally with intervals of ~1 cm.METHODS:A total of 20 patients (3 men, 17 women, mean age, 64.5 years) with gastroesophageal reflux disease and/or hiatal hernia underwent LNF using this procedure.RESULTS:LNF was successful in all 20 patients. There were no complications except for mild dysphagia in two patients, which disappeared within 3 weeks. Improvement of the symptom scores for heartburn, regurgitation, and dysphagia was observed in all patients. The evaluation of the fundoplication by the morphologic scores was quite satisfactory. During a median follow-up period of 30 months, 19 patients exhibited no recurrence, and 1 patient had a mild recurrence but was controlled by PPI on demand.CONCLUSIONS:Our new procedure is very safe and effective to create a proper Nissen fundoplication. In addition, our preliminary findings highlight the feasibility of precise localization of suture points without the need to measure the circumference of the esophagus and that LNF could be performed without a bougie. |
| DOI | 10.1007/s00464-010-0936-y |
| PMID | 20177927 |