The advent of minimally invasive surgery has made it easier to perform a fundoplication (Nissen, Toupet, Dor). Nissen fundoplication is the most frequently performed operation to treat paraesophageal hernias and gastroesophageal reflux in worldwide surgical departments, and laparoscopy has huge advantages over open approach. There is no doubt minimally invasive approach is the gold standard to perform Nissen fundoplication.
There has been a lot of debate about when to treat a paraesophageal hernia. The most usually indication is the presence of symptoms, usually due to gastroesophageal reflux. However, type 3 and type 4 paraesophageal hernias should be eventually operated even in asymptomatic patients due to the risk of serious complications (gastric volvulus, gastric outlet obstruction). Even though there are still no consensus, and patient global health status must also be taken into account.
After assisting a great number of laparoscopic Nissen fundoplications (in Castelo Branco’s Hospital with Dr. Manuel Mega and in CHUC-HG Hospital dos Covões in Coimbra with Dr. Luis de Carvalho) I had the opportunity to perform this technique. A 2,5-3 cm Nissen fundoplication was conducted along with the cruroplasty. Calibration was not used. The procedure was performed uneventfully, and the patient was discharged home in the second postoperative day free of symptoms.
I must thank to Dr Luis de Carvalho (CHUC-HG Hospital dos Covões), a great senior surgeon from whom I have learned a lot and still do, for this opportunity and assistance.
Enjoy.
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Dr. Carlos Eduardo Costa Almeida
General Surgeon
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