Variation in fundic dimensions with respect to short gastric vessel division in laparoscopic fundoplication

Background: This study analyzes the geometry involved in laparoscopic fundo plication with respect to short gastric vessel division for the creation of a tension-free Nissen fundoplication. Methods: For fundoplication, the gastric fundus must be long enough to trav erse the fixed distance between the right edge of the plication and the hig hest lateral fixation of the fundus (distance alpha) and to encircle the es ophagus (esophageal circumference). We compared these two dimensions to the length of fundus available for fundoplication both before and, when needed , after division of the short gastric vessels. Results: For tension-free Nissen fundoplication, the available fundic lengt h must exceed the sum of the esophageal circumference and the distance alph a. In some patients, exceeding this sum requires division of the short gast ric vessels, thereby increasing fundic length. Short gastric vessel divisio n is not necessary in all patients due to significant individual variations in fundic length. Conclusion: There are significant individual variations in fundic length av ailable for fundoplication. The length of the fundus can be increased by di viding short gastric vessels, but it is not always necessary. It is, howeve r, important to take this parameter into consideration when performing the operation in order to avoid postoperative dysphagia.