Mayo stand and back table instruments for Laparoscopic Hiatal Hernia Repair surgery setup

Clamping & Occluding

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  Endo clip applier

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  Kelly Forceps

Cutting & Dissecting

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  Laparoscopic Metz Scissor

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  Metzenbaum Scissor

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  Straight Mayo Scissor

Grasping & Holding

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  Cobra Laparoscopic Grasper

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  Dissecting Laparoscopic Grasper Forceps

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  Fundus Laparoscopic Grasping Forceps

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  Laparoscopic Bowel Grasper

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  Laparoscopic Maryland Dissector Grasper

Retracting & Exposing

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  Army-Navy Retractor

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  Hasson S Retractor

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  Nathanson Hook Liver Retractors

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  Senn Retractor

Suctioning

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  Suction Irrigator

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  Yankauer Suction

Suturing & Stapling

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  Laparoscopic Clip Appliers

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  Laparoscopic Needle Holder

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  Mayo-Hegar Needle Holder

What to expect during Laparoscopic Hiatal Hernia Repair

Positioning: Supine with foot board

Drapes: Folded towels or utility drapes and laparoscopy drape

Anesthesia: General

Surgery Steps: After the patient has been put under general anesthesia, a Foley catheter will be put in them, and they will be prepped and draped. An 11 or 15 blade (surgeon’s preference) is loaded onto a #3 knife handle and is used to make the first incision for a 10mm port. Insufflation tubing will be connected to the port and the CO2 will be turned on by the circulator. A laparoscope will be connected to the camera and light cord and will be placed through the port to look around. A couple of 5mm ports will be placed for the instruments to be placed through. A liver retractor will be put through one of the ports to hold it out of the way for the whole case.

The hiatal hernia will be found after putting the bed in reverse Trendelenburg, which is why the foot board needs to be attached to the bed. A variety of laparoscopic instruments such as wave graspers, Debakey gaspers, Maryland dissectors, and a Harmonic scalpel will be used to take down adhesions and get to the hernia. The surgeon will dissect until the hernia sac is reduced into the abdomen. Once that is done, the esophagus is mobilized to get the length that is needed, followed by dividing the short gastric vessels and moving the fat pad off of the stomach in order to see the GEJ.

A bougie will be placed to prevent GEJ construction, and an endo stapler (commonly several 16mm loads) will be used to perform a gastroplasty to lengthen the esophagus even more. Once the stapler has been fired, a wedge will be made.

An EndoStitch will now be used to partially close the window that was made. a piece of mesh will then be used to close the rest of the defect. The mesh is cut into a U shape and put around the esophagus. A tacking instrument will be used to attach the mesh to the diagram, holding it in place. Excess mesh can be trimmed away with the laparoscopic Metz.

Fundoplication will be done using the EndoStitch again.

An endoscope will be used to check for any leaks in the staple line, and once there are no leaks found, a suction irrigator can be used to irrigate, and the liver retractor and ports can be removed. 0 or 2-0 Vicryl is commonly used to close the deep layer of the larger incision, and 3-0 or 4-0 Nylon or Monocryl can be used to close the skin layers.