Description

Skin-by-skin laparoscopic fundoplication represents a refined and highly structured approach to anti-reflux surgery, focusing on precision at every stage—from the initial skin incision to final closure. This technique is designed to provide durable relief from gastroesophageal reflux disease (GERD) while maintaining minimal tissue trauma, faster recovery, and excellent functional outcomes. With the evolution of minimally invasive surgery, step-by-step demonstration methods have become essential for safe surgical learning and reproducibility. Laparoscopic fundoplication is performed to restore the function of the lower esophageal sphincter by wrapping the gastric fundus around the distal esophagus. The skin-by-skin concept emphasizes systematic dissection, careful identification of anatomical landmarks, and precise suturing techniques. This method ensures that surgeons maintain orientation throughout the procedure, reducing complications and improving long-term patient results. The procedure begins with careful patient positioning and port placement. Proper ergonomic setup is critical to ensure smooth instrument movement and optimal visualization. After gaining laparoscopic access, the surgeon proceeds with gentle dissection of the phrenoesophageal ligament and exposure of the diaphragmatic crura. Preservation of vital structures such as the anterior and posterior vagus nerves is essential to maintain postoperative gastric function. Next, adequate mobilization of the lower esophagus is performed to achieve sufficient intra-abdominal esophageal length. This is a key factor in preventing postoperative recurrence of reflux. Following mobilization, posterior cruroplasty is carried out using non-absorbable sutures to restore the normal hiatal anatomy. The crural repair must be tension-free and anatomically aligned. The fundoplication wrap is then constructed. Depending on patient-specific factors such as esophageal motility, a complete or partial wrap may be created. The wrap must be calibrated carefully to prevent postoperative dysphagia while ensuring strong reflux control. The procedure concludes with final inspection, ensuring hemostasis, correct wrap position, and secure port closure—completing the skin-by-skin surgical pathway. Training in such advanced techniques requires structured mentorship and hands-on exposure. Institutes such as World Laparoscopy Hospital focus on stepwise surgical education, combining live surgery demonstration, simulation training, and evidence-based surgical principles. In conclusion, skin-by-skin laparoscopic fundoplication is a precision-driven anti-reflux surgical technique that enhances safety, consistency, and patient outcomes. With standardized step-by-step execution and advanced laparoscopic skill, this method continues to set high standards in modern minimally invasive gastrointestinal surgery.