Laparoscopic Nissen's fundoplication using an ultrasonic dissector

Summary

This study assessed the efficacy of an ultrasonically activated scalpel, the laparosonic coagulating shears (LCS), in laparoscopic Nissen's fundoplication of 110 consecutive patients who formed the cohort for this study. Patients had short gastric vessel division, starting high on the fundus, freeing from angle of His to the spleen using the LCS. Congenital adhesions between the left sling of the right diaphragmatic crus and retroperitoneal bare area of the stomach were extensively dissected. These were the key technical points in the successful performance of this operation. Mean patient age was 41.2 (range 12–69). 105 patients (95.5%) had a completed laparoscopic Nissen's fundoplication. Mean anaesthetic time was 89.6 min. 101 (92%) had a successful result, with a mean DeMeester score of 1.4 post-operatively (p < 0.02). Two required transfusion, one after a delayed bleed from a port site haematoma and the other after perioperative bleeding. The LCS is a useful adjunct in laparoscopic fundoplication. Short gastric vessel division, mobilisation of the retro-peritoneal bare area of the stomach and maintenance of absolute haemostasis are facilitated by this technology. Symptomatic results are at least comparable to open and laparoscopic Nissen's fundoplication series. The LCS facilitates a laparoscopic approach to the management of gastro-oesophageal reflux disease and negates the risks associated with diathermy.

Key Words:

• laparoscopic Nissen's fundoplication
• gastro-oesophageal reflux
• ultrasonic scalpel