Prof. Van Der Walt

Yeah, I have learned to speak Italian many times.

So now we're going to watch this patient,

and I'm going to explain to you very nicely how to do the surgery.

Excellent.

We're ready to enjoy again once more your operation.

Good.

This patient had surgery in 2013.

and four years after the surgery she started developing symptoms again

now at the present time she's aspirating at night with regurgitation

she's been on ppis after uh four years after the surgery since 2017

and the big problem is she can't sleep she has to sit up straight and sleep

otherwise she aspirates and she's actually had previous lung

infections and aspiration pneumonia so on evaluation she's also got total

breakdown of her nissen the rep also looks in the wrong position and she's

she's from another town so we're going to see what's going on inside and why

she has had the failure

All right, come back a little bit.

All right, jump in.

That's probably a little F and H.

Yeah, it's a cyst.

Okay, like that.

That's quite strong.

Oh, you touched the liver over there.

Step on it and it goes away.

Whew, you've got a big liver.

Is your patient asleep?

The other one is 17, it's 18.

It's still stiff, but it's still stiff.

I wonder if I can lift the liver.

right well you can see she's had the surgery but it never really worked it seems

so let's take this down and see what are we dealing with

you can see she's had a listen but i suspect we have the same problem and that is that the

stomach was put around the stomach and not around the esophagus proper but we'll find out in a

aim is just to identify the vagus nerve which should be right over there is the

vagus nerve you see it whatever that's the name of

the Russian is on some contact JD I say is on some contact when it

Oh, okay.

I don't want to talk to him anymore.

Okay.

All right.

Let's get that liver out of the way.

Yeah.

His pressure is still high.

That's it.

I need to put some pressure on him.

Yeah.

Our anterior vagus is still in contact.

He's still there.

Now I'll get you back.

Here's the fatty pad.

Here's the thing.

Mouth around the mouth.

Same shit.

It looks similar to the other case.

Yeah, same shit.

Exactly, but this time we see the stitch.

Yeah, again you can see this is a surgeon failure, it's not a patient failure.

It's stomach around stomach, there's the fatty pad, there's the esophagus.

This is the stomach, this thing is not close even to the esophagus, nowhere around it.

So, perhaps we can say that the rule of thumb is that we see the fatty pad.

This is the wrong way to perform a lesson.

Yes, it must not be below the fat, but around the stomach.

Yeah, yeah.

So, I think they never mobilized in the right way the esophagus.

Yeah, no, you can see this.

Yes, that part of the esophagus that we opened over there,

this esophagus is still virgin.

Yeah, yeah, absolutely.

It's never been opened.

As I told to Piero some minutes ago,

I think that the surgeon never performed the stitch

through the stomach and the esophagus

because if you have to put a stitch in this way,

is obviously that you can understand that you are not in the right place.

You can see the esophagus.

Yeah.

But you can see this is actually stitched to the stomach.

It was stitched in there.

But as I say, yeah, you're quite right.

If you don't put the stitch there, it will slip down.

Absolutely.

Yeah.

I agree.

Too much fat.

Too much fat.

which is a luck.

It's not always possible.

And it looks like the mobilization was fine, the short gastric vessels have been taken

down.

So, they did the work properly, but not the operation properly.

Sheath of…

The mistake was…

This is all fat pad.

This is all fat pad.

Yeah.

Yeah, the mistake was the wrong landmark.

Yeah, yeah.

Right.

Can we have the nasogastric tubing as well, please?

So, so bueno, Cassini, Donnie.

The wrong landmark and also perhaps they are afraid to mobilize the esophagus.

Yeah, that's usually the, that, I think you're quite right there.

That is usually the reason.

They're scared of the esophagus.

Just hang on, steady.

All right, that's fine.

Thank you.

you could leave it like that so that's the right we're going to deflate the

abdomen clean the lens get rid of the smoke the vapor and whatever right there

we go again this is also quite quite open so I think there's only one stitch

at the back here that seems to be a little bit just one thing that you can

can see in this patient I want to show you is if you pick up the cruz you see

here's a little dimple that's the edge of the aorta over there so if you make that

little dimple then you know you shouldn't go there. She's got a

anterior stitches with this big liver. Let's see what we can do here.

let's talk that over there it's a very big anitis let's see what we can do I can only do so much

let's have a look we're gonna need about three or four stitches here wow she's got that subcapsula

hematoma that's now popped there I got it all stuck in the mark I'll give you a list but I'm not going to follow a list

guitar string

over there.

Wake you up

down, sir.

This is,

I said,

I'm not

the bons

and the

bons

are,

must be

in the

guitar.

Here's

one.

Like,

can you

mention it?

Hi there.

Let's have

a look over

here.

There's

our space.

Perfect.

Good,

and that's

it.

She had

a big

liver.

Excellent,

Ayn.

Listen,

what is

your feeling

doing

a

phantoplication

robotic?

body I think it's a waste of time if you can't operate that if he yeah because it

takes a lot of times and it's very expensive and I suppose if you can't

operate it's a very good option okay so maybe was that all right

all right what do you mean okay in private you mean in private yeah yeah okay okay listen

a couple a couple of things first first of all the more the year suspended the more your

assistant doctors and scrubs nurses and sisters become more beautiful yeah piero i'd like to

to introduce you, this is Dr. Rabe, you've seen her before, this is Dr. Truter, she's

a surgeon as well, and Dr. Rabe has actually just done an Immune surgery at Edinburgh University

in Scotland, and this is my theatre sister, all of you, Master.

Right, right. Oh, listen, when will we see your assistant doctors operating under your

vision? Yes, that I suppose we'll have to do one other time. Anyways, my theatre nurse is

Sister Sonia van den Berghe and she's also been working with me for quite a couple of years.

Right, right, right. Listen, and one more thing, for tomorrow, is it confirmed that you want

broadcast yeah we have yeah we have a lack of patience on the friday afternoon we had two

patients but they they actually pulled out so um we won't be doing that they are already in

plattenberg yeah yeah okay okay this is my pleasure everybody and i'll speak to you soon

anyway excellent stuff excellent procedures I had enjoyed them not so

people certainly that were listening watching you and really fantastic once

again congratulations to all of you and and I speak to you there anyway thanks

very much also or Georgia but let's see the

that thanks you a lot

I send you best regards

same regards to you George as well

I will

see you one of these days, ciao ciao

yes, I wait for you anyway next year

yeah

thank you

thank you very much also for me

thank you very much also for me, bye