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laparoscopic anti-reflux procedures

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Traditional fundoplication to treat oesophageal reflux has been carried out laparoscopically via an abdominal approach. An alternative is the laparoscopic use of a mobilised falciform ligament to wrap around the oesophagus: a ligamentum teres cardiopexy. Both techniques are still not widely established, but they offer considerable advantage to the patient, e.g. decreased pain and increased cosmesis.

Indications for laparoscopic anti-reflux procedures include:

  • intractable oesophagitis
  • failure of medical therapy
  • onset of complications, e.g. Barrett's oesophagus
  • chronic anaemia

Contraindications include:

  • prior vagotomy or partial gastrectomy
  • an enlarged left lobe of the liver as the laparoscopic field of view is reduced
  • oesophageal shortening

Potential complications include injury to any of the organs in the vicinity, pneumothorax and 'gas bloat syndrome' due to excessive constriction of the oesophagus.

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