Fig. 5.14   Short floppy fundoplication around a 6OFr bougie

Finally, the hiatal area is irrigated and a careful check is done for hemostasis. All fluids must be aspirated with the patient in a normal position to avoid residual fluid in the left hypochondrium. The ports are removed and all wounds are closed.A nasogastric tube is left in place for 24 h selectively.

Postoperative Course

Patients are encouraged and assisted to ambulate the same night after surgery. They are started on a liquid diet on the first postoperative day and allowed a very soft diet later. A patient who has normal vital signs, urinates well, and tolerates fluids and a soft diet is authorized to leave the hospital as early as the first or second postoperative day.

Early in the author’s experience, all patients were given a gastrographin upper gastrointestinal study to ensure the wrap was in place and there was no leak. This is no longer done as confidence in the operation has been gained. Patients are advised of the importance of continuing on a very soft diet for about 30 days, fractioning the meals to five a day and avoiding carbonated sodas, meat, chicken, and bread. This minimizes the temporary swallowing discomfort that some patients experience.