Endoscopic clipping of the Z-line (CMZL) helps recognize anatomical failures after Nissen fundoplication: technical report of a new method

Barkhatov, Leonid; Kazaryan, Airazat M.; Aasen, Steinar; Edwin, Bjørn
July 2015
Videosurgery & Other Miniinvasive Techniques / Wideochirurgia i;2015, Vol. 10 Issue 3, p363
Academic Journal
Introduction: Nearly 15% of patients after laparoscopic antireflux surgery experience recurrence of symptoms or develop new gastrointestinal symptoms. Some of them require redo procedures. It can be demanding to reveal anatomical failure after previous fundoplication. Aim: To present a method which assists in recognition of anatomical failures after Nissen fundoplication. Material and methods: Five patients with previous laparoscopic Nissen fundoplication and severe gastrointestinal symptoms were included in this study. During the esophagogastroduodenoscopy (EGDS) two radiopaque metal clips were placed to mark the Z-line ("clips-marked Z-line" - CMZL). It was done to achieve precise visualization of the gastroesophageal junction area in the video contrast investigation. Distinctions between conclusions after the EGDS, ordinary video contrast investigation, video contrast investigation with CMZL and intraoperative findings were analyzed. Results: All patients underwent laparoscopic refundoplication with good postoperative results. There were 4 cases misdiagnosed by contrast investigation without clips and four cases misdiagnosed by EGDS. Endoscopic clipping helped to recognize correctly all anatomical failures. Conclusions: Applying CMZL as a routine investigation before redo fundoplication can reduce frequency of misdiagnosis and help to perform redo fundoplication in appropriate patients, but it requires further studies on larger cohorts of patients.


Related Articles

  • Face, content, and construct validity of four, inanimate training exercises using the da Vinci Si surgical system configured with Single- Site instrumentation. Jarc, Anthony; Curet, Myriam // Surgical Endoscopy;Aug2015, Vol. 29 Issue 8, p2298 

    Background: Validated training exercises are essential tools for surgeons as they develop technical skills to use robot-assisted minimally invasive surgical systems. The purpose of this study was to show face, content, and construct validity of four, inanimate training exercises using the da...

  • Nissen fundoplication: three causes of failure (video). Morgenthal, Craig; Smith, C. // Surgical Endoscopy;Jun2007, Vol. 21 Issue 6, p1006 

    Laparoscopic Nissen fundoplication (LNF) has become the most commonly performed antireflux procedure for gastroesophageal reflux disease. The rate of failure following fundoplication varies from 2% to 30%, and revision is required in many of the patients who have recurrent or new foregut...

  • Endoscopic aqueductoplasty in the treatment of aqueductal stenosis. Luciano da Silva; Samuel Zymberg // Child's Nervous System;Nov2007, Vol. 23 Issue 11, p1263 

    Abstract Objective  Endoscopic aqueductoplasty is an option of treatment of obstructive hydrocephalus caused by aqueductal stenosis. We report on our experience with this endoscopic technique. Materials and methods  Eighteen patients with primary or secondary...

  • Value of the SAGES Learning Center in introducing new technology. Hanly, E. J.; Zand, J.; Bachman, S. L.; Marohn, M. R.; Talamini, M. A. // Surgical Endoscopy;Apr2005, Vol. 19 Issue 4, p477 

    Background: The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Learning Center is a group of educational "classrooms" designed to tutor meeting attendees on specific technology-intensive content areas. The objectives of the Robotics Station were to familiarize...

  • Combination of water-jet dissection and needle-knife as a hybrid knife simplifies endoscopic submucosal dissection. Lingenfelder, Tobias; Fischer, Klaus; Sold, Moritz G.; Post, Stefan; Enderle, Markus D.; Kaehler, Georg F. B. A. // Surgical Endoscopy;Jul2009, Vol. 23 Issue 7, p1531 

    The safety and efficacy of endoscopic submucosal dissection (ESD) is very dependent on an effective injection beneath the submucosal lamina and on a controlled cutting technique. After our study group demonstrated the efficacy of the HydroJet in needleless submucosal injections under various...

  • A multitasking platform for natural orifice translumenal endoscopic surgery (NOTES): a benchtop comparison of a new device for flexible endoscopic surgery and a standard dual-channel endoscope. Spaun, Georg O.; Bin Zheng; Swanström, Lee L. // Surgical Endoscopy;Dec2009, Vol. 23 Issue 12, p2720 

    A unique endoscopic platform with two independent end-effectors, each with five degrees of freedom, and an ergonomic user interface has been developed to address the needs of complex endolumenal and natural orifice translumenal endoscopic surgery (NOTES) procedures. This study aimed to measure...

  • A computerized analysis of robotic versus laparoscopic task performance. Narula, Vimal; Watson, William; Davis, S.; Hinshaw, Kristen; Needleman, Bradley; Mikami, Dean; Hazey, Jeffrey; Winston, John; Muscarella, P.; Rubin, Mike; Patel, Vipul; Melvin, W.; Narula, Vimal K; Watson, William C; Davis, S Scott; Needleman, Bradley J; Mikami, Dean J; Hazey, Jeffrey W; Winston, John H; Melvin, W Scott // Surgical Endoscopy;Dec2007, Vol. 21 Issue 12, p2258 

    Introduction: Robotic technology has been postulated to improve performance in advanced surgical skills. We utilized a novel computerized assessment system to objectively describe the technical enhancement in task performance comparing robotic and laparoscopic...

  • Robotically assisted small intestinal strictureplasty in dogs: a survival study involving 16 Heineke-Mikulicz strictureplasties. Sonoda, T.; Lee, S.; Whelan, R.; Le, D.; Foglia, C.; Venturero, M.; Hunt, D.; Nakajima, K.; Milsom, J.; Whelan, R L; Milsom, J W // Surgical Endoscopy;Dec2007, Vol. 21 Issue 12, p2220 

    Background: Robotically assisted surgery offers the advantages of improved dexterity and elimination of tremor over conventional laparoscopic surgery. There have been few studies to date, however, examining the role of robotics in intestinal surgery. This study was undertaken to...

  • Minimally invasive surgery training using multiple port sites to improve performance. White, Alan; Giles, Oscar; Sutherland, Rebekah; Ziff, Oliver; Mon-Williams, Mark; Wilkie, Richard; Lodge, J. // Surgical Endoscopy;Apr2014, Vol. 28 Issue 4, p1188 

    Background: Structural learning theory suggests that experiencing motor task variation enables the central nervous system to extract general rules regarding tasks with a similar structure-rules that can subsequently be applied to novel situations. Complex minimally invasive surgery (MIS)...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics