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Wideochir Inne Tech Maloinwazyjne. 2015 Sep;10(3):363-7. doi: 10.5114/wiitm.2015.54315. Epub 2015 Sep 21.

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

Author information

1
The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway ; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
2
The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway ; Surgical Department, Finnmark Hospital, Kirkenes, Norway.
3
Radiology Department, Oslo University Hospital - Rikshospitalet, Oslo, Norway.
4
The Intervention Centre, Oslo University Hospital - Rikshospitalet, Oslo, Norway ; Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway ; Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway.

Abstract

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.

KEYWORDS:

endoscopic clipping; failed fundoplication; laparoscopic fundoplication; redo surgery; slipped Nissen

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