GERD

Question 1

Workup for reflux prior to surgery

Answer 1

pH testing
esophgaeal motility testing
esophagram
endoscopy/biospy

Question 2

Steps to Nissen fundoplication

Answer 2

1. lap vs open entry
2. incise gastrohepatic ligament to expose hiatus
3. circumferential dissection of esophagus
4. crura closed (1-4 2-0 prolene sutures)
5. take down gastrospelinc/short gastrics
6. floppy fundoplication - 360 degree wrap over 50-54fr bougie
7. leak test