Complications - Fundoplication, laparoscopic according to Toupet

  1. Intraoperative Complications

    Spleen Injury

    • Prevention through subtle preparation
    • Hemostatic measures (coagulation, hemostatics)
    • Splenectomy as a last resort

    Esophageal/Stomach Wall Injury

    • Prevention through subtle preparation
    • Estimate the removal of the hernia sac in large hernias, if the risk is too high, only detach the hernia sac from the diaphragmatic crura and leave the hernia sac in the mediastinum.
    • Diagnosis possible through intraoperative blue test,
      therapy by suturing the defect and ideally covering it with the wrap.
    • Possibly intraoperative endoscopic control
    • In case of esophageal lesion: prefer Nissen fundoplication and avoid additional sutures on the esophagus

    Bleeding

    • Short Gastric Arteries:
      • Possible complication during the transection of the short gastric arteries for stomach fundus mobilization.
      • Hemostasis can be challenging due to poor exposure in severe visceral obesity.
    • Diaphragmatic Veins:
      • In close proximity to the hiatus,
      • Hemostasis can also be challenging.
    • Aorta
      • Runs behind the hiatus
      • An injury is theoretically possible.

    Pneumothorax

    • Due to injury of the parietal pleura during mediastinal preparation
    • Initially without consequence in stable patients
    • With increasing ventilation pressure or poor oxygenation, initially reduce intra-abdominal pressure or directly place an intraoperative chest drain
    • At the end of the operation, good lung ventilation through manual ventilation with open trocars
    • After releasing the pneumoperitoneum, a rapid regression of the pneumothorax is expected.
Postoperative complications

DysphagiaMost relevant problem after laparoscopic fundoplicationMust be differentiated:Immediately

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