RNY to GJ-S with modified Nissen

Technique Description:

• 1. Reduction of herniated intra-thoracic pouch
• 2. Gastrojejunal sleeve resection
• 3. Cruroplasty
• 4. Modified Nissen Fundoplication
• 5. Sugerman-type distalisation

Learning Points:

• During Gastrojejunal Sleeve Resection it is important to exclude the old stapler line to avoid Ischemia and leakage at the level of the stapler line
• Upgrade cartridge when tissue is thicker to prevent leaks
• Modified Nissen is a good technical solution to avoid recurrence of hiatal hernia on top of the cruroplasty
• Modified Nissen Fundoplication
• Pexia of the Nissen wrap to the crus is an additional technique to avoid recurrence of hiatal hernia