K. PUCHKOV

okay okay and now it's normal i beg your pardon can you try and have the microphone closer to you and

okay thank you thank you okay thank you uh i would like introduce my colleagues

uh and my uh second assistant and my first assistance uh julia and my scrub knows olga and

And this is my OP team.

Yulia, some words for this case.

It's okay.

Some words about our patient.

She is a woman, age 55.

She complains of the pain in the chest,

epigastric burning, and acid lactation.

According to her X-ray and gastroscopy examinations,

she has diaphragmatic hernia.

She has undergone treatment several times,

and every time without the problem effect and it requires an operation the first step we separate

the anterior wall of the esophagus we do this with the help of five millimeter ligature device we do

this without blood loose with the minimal damage of surrounding tissue and very quickly it seems

You can see the right diaphragmatic cross.

Now we are going to change the direction of the traction of the fundus

and we continue to dissect the fundus of the stomach.

How long has this patient been on PPI? How many years?

About three years.

without blood loss and very quickly we dissect the left diaphragmatic cross and left wall of

the esophagus we can see the separated left diaphragmatic cross and the left wall of the

the esophagus yes the images are perfectly clear no problem at all in this sense no problem we do

the exposition in the gastroesophageal junction zone and then we are going to dissect the right

wall of the esophagus we are ligating and cutting some arteries that spring from the left gastric

Now we can see the spleen in the window now.

It seems to me it's autumn and we must see the posterior vagus.

Just a moment. We dissect the posterior wall of the esophagus.

This is the posterior vagus. Can you see it?

Can you see the posterior vagus?

Yes, the images are really good. Yeah, no problem.

We insert the retractor for the esophagus upward.

It is posterior vagus, mastasis.

non-absorbable synthetic braided suture we perform extra corporal suture for this

We have a question from Professor Barbieri.

Good morning and congratulations for your procedure.

Do you have any experience with a prosthetic mesh for a hiatus closure?

No, we haven't.

So even if a hiatus is very big, you don't close with a prosthetic mesh?

We haven't used it.

After this operation with using the mesh is recurrence in 30% of the cases.

big size, the rupturator. Do you have any gastric suction tube or a

bougie inside the esophagus? Two centimeter flexible probe into the esophagus

and stomach. Okay, thank you.

We use unabsorbable braided synthetic suture,

Sorgidac 3-Z room, and a pricking needle.

And we use, in this situation, intercorporeal suture

because we must do it very carefully without tension.

The camera very well.

It's necessary for good visualization suture.

We capture the rest of the diaphragmatic esophagus ligamentum in this suture.

We can capture the rest of the cranial ligamentum in the first suture.

We have been doing this operation during 15 years.

We have done about 600 audit durations of the operation, about one hour, hospital stay period two or three days, and diet period about two months.

How about complications? What's about complications? The number of complications depends on the surgeon's skills. At the beginning of mastering this technique, we had two perforations of the esophagus and we closed the wound immediately.

and two cases of the left pneumothorax.

We close pleura immediately and puncture the pleura cavity.

Now we have good experience in these operations,

and possible complications can be dysphagia and recurrence.

Dysphagia in 5% of the cases and recurrence in one year.

2% of their cases, and in five years, up to 5% of the cases.

I'd like to explain why we choose the fund application by TORPM.

According to our data, dysphagia is the main problem of fund application by Nissan.

It takes place in 25% of the cases, and it can be absorbed during two months.

In our situation, dysphagia can be present in 5% of the cases and during two days.

As for anti-reflex results, they are the same in both cases.

So, the next advantage of our approach, unlike the classification by NISA, our approach preserves

the ability to vomit and to eructate. Our patients don't have bloating syndrome

and it's very important for health-related quality of life.

You just anticipated us. It was just the next question you should have done, but you

You just told us something about it before our question.

Just a moment, just a moment, sorry.

In this place we use a single loop of suture.

It's very important to do it gently, without tension.

The plastic is floppy.

We can easily tell there is a huge skin, a huge experience under this.

It looks like it's very easy, but because of your huge experience for sure.

We do bilateral fundoplication by taupe,

and esophagus gets carved through 270 degrees in these cases.

We have finished now.

We must change.

Any drainage under?

No, we need drainage. We are going to change the probe by a thin probe, and we left it for 12 hours.

When do you start feeding the patient?

Next day.

Okay, perfect.

Thank you very much.

On behalf of Professor Palazzini, I just want to thank you for being with us today.

Thank you.

and you have been the first surgical procedure on the main screen in the audience

that it's totally crowded now, people standing to sit.

No people sitting anymore because everything is full.

So thank you very much again.

And I know that Professor Puchov will be with us tonight.

So they told me it would be a great pleasure to meet him.

Goodbye, thank you.

Thank you.

Thank you so much.

Thank you.

Thank you.