Transabdominal esophagotomy with fundus covering

The fundus cover is to embed the esophagus into the stomach wall and play a role in anti-reflux. The method is to cover the mucosa bulging part of the muscle layer incision, so that the cardia notch can be sharpened, and the cutting edge of the muscle layer can be separated to protect the esophageal mucosa and prevent rupture. Treatment of diseases: gastroesophageal reflux disease, reflux esophagitis Indication Transabdominal esophageal incision fundus covering is applicable to: 1. The medical treatment is not effective, the esophageal dilatation and flexion are obvious, or there are other pathological changes, such as supraorbital diverticulum, hiatal hernia or suspected cancer. 2. Have undergone dilatation treatment, or lead to gastroesophageal reflux and esophagitis. 3. The symptoms are severe and do not want to be esophageal dilatation. Contraindications 1. Patients with severe heart and lung function. 2. The nutritional status is low, and the hemoglobin is lower than 6.0g/L. Preoperative preparation 1. People with malnutrition should be corrected before surgery. They can be intubated through central venous, supported by parenteral nutrition or treated with internal medicine or dilatation, so that they can enter the liquid food by mouth. 2. Patients with pulmonary complications should be treated appropriately. 3. Because the food is retained in the esophagus, the esophagus has different degrees of inflammation. The esophagus should be inserted into the stomach tube once a day for 3 days before surgery, and the antibiotic solution is injected after washing. Repeat 1 time before anesthesia to remove the accumulated secretions overnight and leave the stomach tube. Premedication should not be given to pills or tablets. Surgical procedure 1. Complete the esophageal myotomy, cut off the short gastric artery and free the bottom of the stomach. 2. Use the anterior wall muscle of the stomach to cover the left margin of the esophageal muscle layer. The highest needle should exceed the tip of the muscle incision, and the lowest needle is at the junction of the esophagus and stomach. 3. The right esophageal margin and the fundus pulposus suture, completely covering the esophageal mucosa. 4. The fundus cover is completed, and the stomach and the diaphragm are fixed by several needles. Note that the stomach wall needle cannot penetrate the mucosa. 5. After the stomach bottom is free, the stomach bottom is bypassed from the back of the esophagus, sutured in the muscle layer incision, covering the incision of the esophagus. complication Common complications after esophageal myotomy are esophageal mucosal perforation, gastroesophageal reflux, esophageal hiatus hernia and symptoms are not relieved.