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1. Introduction
2. Portal Placement
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a. Place Left Side Instrument Trochar
b. Retract Left Lateral Segment of Liver
c. Place Second/Third Trochars Completing Triangle
3. Mobilize Hernia Sac from Crus
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a. Dissect Gastro-Hepatic Ligament
b. Dissect Hernia Sac off Left Crus
c. Dissect Hernia Sac off Right Crus
d. Dissect Posterior Aspect of Sac
e. Identify Posterior Vagus
f. Transect Short Gastric Arteries
g. Dissect Hernia Sac from Greater Curve of Stomach
h. Expose Esophagus Cephalad to Sac and Identify Ant. Vagus N.
4. Separate Stomach from Hernia Sac
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a. Dissect Hernia Sac from Stomach Via Inner Sac
b. Excision of Hernia Sac
c. Continue Hernia Sac Dissection of Stomach
d. Dissect Lesser Curvature of Stomach
5. Dissection of GE Junction and Esophagus
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a. Further Mobilization of the Esophagus
b. Dissect Mediastinal Pleura Tissue from Spine/Aorta
c. Place Blue Loops around GE Junction
d. Continue Dissection of Posterior Hernia Sac from Stomach
e. Dissect Lower End of Left Crus
6. Crural Closure
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a. Combined Extra and Intracorporeal Knotting Technique
b. Ensure Esophagus Dissected and Lengthened
7. Toupet Fundoplication and Gastropexy
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a. Align Short Gastric Arteries
b. Posterior Gastropexy
8. Excision of Suspected Benign Mass
9. Port Site Closure
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Laparoscopic Paraesophageal Hernia Repair
David Rattner, MD
Douglas Cassidy, MD
Massachusetts General Hospital
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General Surgery
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Authors
David Rattner, MD
Douglas Cassidy, MD
Filmed At:
Massachusetts General Hospital
Article Information
Publication Date
N/A
Article ID
126
Production ID
0126
Volume
N/A
Issue
126
DOI
https://doi.org/10.24296/jomi/126