Kasturba Hospital surgery recently performed a fundoplication procedure on a 45-year-old woman with a large hiatus hernia. This groundbreaking surgical technique has effectively managed her gastroesophageal reflux disease (GERD) symptoms, providing renewed hope for patients suffering from similar conditions.
The patient was referred to Kasturba Hospital after experiencing typical symptoms of GERD, including retrosternal burning and recurrent food regurgitation, for the past 3-4 years. A computed tomography (CT) scan revealed a substantial sliding hiatus hernia, where more than 30-40% of the stomach had herniated into the chest cavity, classifying it as a "giant hernia."
After thorough preoperative counselling, the patient underwent a laparoscopic Nissen's fundoplication procedure with a complete fundal wrap. The surgical team embarked on the laparoscopic approach, carefully dissecting the dilated esophageal hiatus, which measured 10 x 6 cm. “The challenge lay in the proximity of vital structures such as the heart, aorta, and inferior vena cava. Complicating matters, the patient had an enlarged and heavy left lobe of the liver. However, with utmost precision and minimal blood loss, we successfully achieved an optimal dissection, reducing the hernia and attaining an ideal 5-6 cm length of intra-abdominal esophagus”, said Dr Jategaonkar (Professor & GI Surgeon, Department of Surgery)
A short, floppy 360-degree wrap, from the fundus of the stomach, was then meticulously plicated around the lower end of the esophagus. This innovative technique aimed to prevent food regurgitation and improve the patient's quality of life. The entire laparoscopic procedure, a testament to the surgical team's expertise, concluded within approximately 2.30 hours.
Remarkably, the patient displayed a swift recovery. On the first postoperative day, she was already ambulatory, demonstrating her restored mobility and was able to tolerate liquids with ease. “This outcome highlights the significant benefits of minimally invasive GI surgery, which expedite healing and reduce postoperative complications”, said Dr Ramesh Pandey (Deputy Medical Superintendent, Kasturba Hospital)
“Our hospital takes pride in having conducted approximately 25 cases of laparoscopic fundoplication over the past few years, each resulting in positive patient outcomes. This success can be attributed to the collaborative efforts of our skilled Surgery team. We eagerly anticipate undertaking more groundbreaking procedures in the future, as we continue to push the boundaries of medical innovation”, said Dr Poonam Shivkumar Varma (Medical Superintendent, Kasturba Hospital)