BACKGROUND: Laparoscopic Nissen fundoplication (LNF) is gaining popularity. Although the hemodynamic effects of the typical @entity516 have been studied, the additional consequences of the hiatal dissection necessary for LNF have not. METHODS: Seven female @entity1707 were anesthetized, intubated, and ventilated with a volume ventilator and hemodynamic and mechanical pressure monitoring devices were placed. Pressures were recorded every 15 minutes for 1 hour after each of four interventions: (1) anesthesia induction, (2) @entity515 @entity516 (15 mm Hg), (3) LNF, and (4) release of @entity516 (and removal of ports). RESULTS: Right atrial, inferior vena caval, mediastinal, pleural, airway, and pulmonary capillary wedge pressures all increased after @entity516 (p < 0.05). Only mediastinal pressure (8.6 vs 13.7 mm Hg, @entity516 vs LNF; p < 0.05) and pleural pressure (2.6 vs 3.5 mm Hg, @entity516 vs LNF; p < 0.05) showed a further significant increase after LNF. In addition, cardiac output fell significantly after LNF (5.9 vs. 4.6 L/min; p < 0.05). Mediastinal pressure and cardiac output remained significantly altered after the release of @entity516 . CONCLUSIONS: Surgical disruption of the esophageal hiatus during LNF causes both increased mediastinal and pleural pressure and a significant @entity998 . These findings uncover a previously unsuspected physiologic detriment that may occur during LNF.

Increased mediastinal pressure and XXXX during laparoscopic Nissen fundoplication.

@entity1707 :: ('9823', 'Species') :: ['pigs'] @entity516 :: ('MESH:D011027', 'Disease') :: ['pneumoperitoneum'] @entity998 :: ('MESH:D002303', 'Disease') :: ['reduction in cardiac output'] @entity515 :: ('CHEBI:29334', 'Chemical') :: ['CO2']
@entity998 :: (MESH:D002303,Disease) :: ['decreased cardiac output']
