Laparoscopic anti-reflux procedures

Traditional fundoplication to treat oesophageal reflux has been carried out laparoscopically via an abdominal approach. An alternative is the laparoscopic use of a mobilised falciform ligament to wrap around the oesophagus: a ligamentum teres cardiopexy.

Indications for laparoscopic anti-reflux procedures include:

• intractable oesophagitis
• failure of medical therapy
• onset of complications, e.g. Barrett's oesophagus
• chronic anaemia

Contraindications include:

• prior vagotomy or partial gastrectomy
• an enlarged left lobe of the liver as the laparoscopic field of view is reduced
• oesophageal shortening

Potential complications include injury to any of the organs in the vicinity, pneumothorax and 'gas bloat syndrome' due to excessive constriction of the oesophagus.