Applying traction to fundoplication by means of a Penrose drain in gastro-oesophageal reflux surgery in difficult cases of hiatal hernia

Abstract

Gastroesophageal reflux disease (GERD)-associated symptoms, such as pyrosis and regurgitation, are common and affect about 20% of subjects in the general population [1]. Laparoscopic surgery has revolutionised the field of hiatus surgery, particularly in treatment of gastro-oesophageal reflux byfacilitating the procedureandreducingpostoperativecomplications[2]. The surgeon's preference and preoperative radiographic findings on esophageal motility determine whether to perform a circumferential ‘floppy’ fundoplication [3] or a partial fundoplication [4,5]. One of the most complex steps in this type of surgery is to pass the gastric fundus through the retro-oesophageal tunnel, a manoeuvre which in certain circumstances (for example, in patients with obesity, or in reinterventions) can be highly problematic. We propose a surgical manoeuvre using a Penrose drain to overcome this problem.