caa a22 4500 475780973 CHVBK 20180406123644.0 cr unu---uuuuu 170329e20000801xx s 000 0 eng 10.1007/s004640000172 doi (NATIONALLICENCE)springer-10.1007/s004640000172 Geometry and reproducibility in 360° fundoplication [Elektronische Daten] [P. Reardon, B. Matthews, T. Scarborough, A. Preciado, J. Marti, J. Kamelgard] Background: In this study, we set out to precisely define two symmetrical points—a on the anterior fundic wall and b on the posterior fundic wall. These points, when advanced around a 60-Fr bougie-filled esophagus, will meet on the right side, to the right of the anterior vagus nerve, to create a reliable, reproducible, loose (i.e., or "floppy”) 360° fundoplication (FP). Methods: For the terms of this study, circumference=c; diameter=d; c/d=π; π=3.14; and d(cm)=Fr/30. Using a flexible plastic ruler, we measured, in cadavers (n=5) and intraoperatively (n=16), esophageal c at the gastroesophageal junction (GEJ) with a 60-Fr bougie in place; d was calculated from c. Results: The smallest measured value for c was 7.5 cm (d=2.39 cm); the largest value for c was 10.0 cm (d=3.18 cm). The mean value was 8.35 cm (d=2.66 cm). Points a and b are established by measuring laterally from a point where the greater curve meets the GEJ in the bougie-filled esophagus. Point a is 6.0 cm laterally and 6.0 cm below the short gastric vessels on the anterior fundus; point b is 6.0 cm laterally in a symmetrical position on the posterior fundus. Connecting these three points as a line defines the inner c of the completed FP and measures 12.0 cm. This gives an internal d of 3.82 cm for the FP. This is >1 cm larger than d for the mean measured external esophageal c of 8.35 cm where d=2.66 cm. This technique creates a correctly oriented, symmetrical, "floppy,” true fundoplication. It avoids wrapping or twisting the fundus around the GEJ. The technique is easily taught and reproducible. Conclusions: Two points, measured a horizontal distance of 6.0 cm from the GEJ, symmetrically placed on the anterior (point a) and posterior (point b) fundus can be brought anterior (a) and posterior (b) to the esophagus and sutured to the right of the anterior vagus nerve to reliably and reproducibly create a "floppy” 360° fundoplication. Springer-Verlag, 2000 Esophagus nationallicence Geometry nationallicence Fundoplication nationallicence Circumference nationallicence Diameter nationallicence Laparoscopy nationallicence Traction suture nationallicence Reardon P. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut Matthews B. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut Scarborough T. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut Preciado A. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut Marti J. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut Kamelgard J. New Jersey Medical School, 185 South Orange Avenue, MSB G-506, 07103-2714, Newark, NJ, USA aut Surgical Endoscopy Springer-Verlag 14/8(2000-08-01), 750-754 0930-2794 14:8<750 2000 14 464 https://doi.org/10.1007/s004640000172 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s004640000172 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Reardon P. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut NATIONALLICENCE 700 1- Matthews B. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut NATIONALLICENCE 700 1- Scarborough T. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut NATIONALLICENCE 700 1- Preciado A. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut NATIONALLICENCE 700 1- Marti J. Department of Surgery, Baylor College of Medicine, 6550 Fannin, 77030, Houston, TX, USA aut NATIONALLICENCE 700 1- Kamelgard J. New Jersey Medical School, 185 South Orange Avenue, MSB G-506, 07103-2714, Newark, NJ, USA aut NATIONALLICENCE 773 0- Surgical Endoscopy Springer-Verlag 14/8(2000-08-01), 750-754 0930-2794 14:8<750 2000 14 464 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer