ABSTRACT
An adequate fundic wrap is fundamental to the success of conventional and laparoscopic Nissen fundoplications. Nevertheless, up to now there has been no standardized method for the surgeon to determine intraoperatively the width and tension of the fundic wrap according to objective criteria. With the support of Rüsch (Kernen, Germany), we developed a measurement balloon for use in laparoscopic Nissen fundoplication. The balloon allows the surgeon to define the width of the wrap and predetermine its length, as well as to measure its tension. Depending on the measured balloon pressure, the surgeon can perform fundic sutures more or less tightly. On the basis of 41 fundoplication model tests, we found that a fundic wrap typically described as "loose and floppy" produced a balloon pressure of 50-60 mmHg. In 10 laparoscopic Nissen fundoplications on domestic pigs, we were able to adjust the fundic wrap intraoperatively to a balloon pressure in this range (mean; 53.5; SD; 2.25). After the optimal intraoperative balloon pressure in humans has been investigated in a prospective study that is in progress, the Tübingen balloon is expected to serve as an instrument for quality assurance in reflux surgery.
Subject(s)
Catheterization , Fundoplication/methods , Laparoscopy/methods , Animals , Equipment Design , Feasibility Studies , Female , Gastroesophageal Reflux/surgery , Suture Techniques , SwineABSTRACT
Although the effects of using video display terminals (VDTs) have been examined from a number of perspectives, there has been relatively little study of the effect of small uncorrected refractive errors in the production of visual discomfort. The purpose of this study was to examine the level of six commonly assessed symptoms in a sample of 32 VDT operators via a questionnaire and to determine whether these were related to their habitual small refractive errors. The subjects reported substantial prevalence (55-81%) of each of the symptoms except double vision (16%). After a complete vision examination, the VDT operators were classified as relative myopes, hyperopes, astigmats or emmetropes. The criterion was a minimum of 0.50 D in the most ameotropic eye. Using this criterion, analysis showed that small refractive errors were significantly related to the reported level of symptoms of VDT operators. These results suggest the utility of proper refractive correction for the comfortable use of a VDT and the value of further research into this putative causal relationship.
