Laparoscopic Hiatal Hernia Repair and Funduplication

Gastroesophageal reflux disease (GERD) is very common. Traditionally a medical condition, however, there is increasing evidence that laparoscopic surgery provides a definitive treatment, avoiding a lifetime medical treatment, particularly in the young age group. There are different types of funduplication (gastric wrap around the esophagus) so we normally perform a tailored procedure on an individual basis.

Treatment of Barrett Esophagus

Barret esophagus is an esophageal disease secondary to GERD that represents a pre-malignant condition. Laparoscopic anti-reflux surgery represents the only way to prevent progression of the disease and sometimes, as shown in a recent study done at our Institution, regression of Barrett's. This is accomplished by a laparoscopic anti-reflux procedure and a careful follow-up schedule that includes upper GI endoscopies.

Laparoscopic Esophageal Myotomy (Heller's Procedure)

When the sphincter at the gastro-esophageal junction fails to relax after a normal swallow, it leads to a condition called achalasia. This eventually causes dilation of the distal esophagus and painful swallowing (also know as dysphagia). Surgery is the definite treatment and is done by incising the muscular layer of the esophagus (myotomy). We normally associate an antireflux procedure to prevent the possible GER due to myotomy.

Laparoscopic Treatment of Peptic Ulcer Disease

Although nowadays peptic ulcer disease is a medical condition, sometimes a surgical treatment is needed. This is especially true when an ulcer perforates the wall of the affected organ, which represents a surgical emergency. A laparoscopic suture repair of the perforation is our procedure of choice and the patient can normally leave the hospital en 48 h. Sometimes, however, surgery is needed for long-term control of the disease after failure of medical treatment, and then we prefer to perform a selective anterior vagotomy (Taylor's vagotomy)