270o Toupet fundoplication
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Opening ligament between stomach and liver with exposure right side oesophagous
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Mobilisation left side oesophagous and upper part of stomach
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Oesophagous retracted superiorly showing wide defect (hole) in diaphragm
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Closure of the hiatus hernia (diaphragmatic crus) with interrupted non absorbable surgical sutures
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Upper part of stomach (fundus) pulled through behind the lower oesophagous
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270 Toupet fundoplication completed
180o anterior Dor fundoplication
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Mobilisation of the herniated stomach through a large diaphragmatic (hiatus hernia) defect
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Stomach completely reduced between the spleen (left upper quadrant abdomen) and liver (right upper quadrant abdomen)
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Dissection of the hernia sac with a harmonic scalpel (ultrasound powered cutting tool)
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Laparoscopic view of the mediastinum (space in the chest between the lungs) after complete excision of the hernia sac
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Closure of the hiatus hernia (diaphragmatic crus) with interrupted non absorbable surgical sutures
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Diaphragmatic hiatus hernia completely closed
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Hernia repair reinforced with placement of a special soft “V” shaped prosthesis fixed with fibrin glue
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Repair completed by the formation of a partial anterior fundoplication (upper portion of the gastric wall wrapped in front of the oesophagous)
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Final laparoscopic view of the stomach sitting in its correct position into the abdominal cavity and partially covered by the liver