I do two or three interrupted TiCron sutures to re-oppose the crura and three interrupted TiCrons a centimetre apart to form the wrap.  It is non-absorbable and in the few revisions i have done it is easy to find.  It also holds the laparoscopic knot well and allows the knot to slide down easily.

Broadly agree with Deepraj S. Bhandarkar to approximate the crura also use Ethibond 2-0, what color is an advantage if used Ethibond Excel feature that highlights its glide more easily, also I put knots in eight at least in the first point, 2-3 for interrupted sutures and three interrupted sutures crura for wrap, the same material used for other types of fundoplication including Heller-Dor in Achalasia

Vicryl 3/0 or 2/0 using either intracorporeal or extracorporeal knotting depending on the available instruments. 

Well I wouldn't use Vicryl!    Crazy.  Sure fire way to get an acute diaphragmatic hernia when the suture dissolves in 21 days.   Also the wrap will certainly just fall apart at that time also.   The standard of care is permanent suture!

I don't like ethibond personally (although braided I still find it slips and I don't like the tissue reaction it causes) and I prefer 2/0 prolene with extra-corporeal knots.    Reoperatively there is no fibrosis with prolene and the sutures are easy to find.

I prefere interrupted TiCron suture. 

I use interrupted 2/0 ethibond either by extracorporeal or intracorporeal knotting

Hi everyone.

Started many years ago with silk (that was how I was taught).

Shifted to Ethibond/TiCron, and later to Gore CV-0.

The more recent years I have become a monofilament fundamentalist, so now I suture (intracorporeally) with polypropylene 2-0 (eg Prolene). Four throws are adequate, but they need to be correctly oriented; if you accidentally create a slip-knot, even 5 throws or more will not create a secure knot.

I close the crura with unidireccional barbed suture (Quills #2 Prolene)   is a novel technique that we described and have been using it for over  4 years with very good results. We havent use MESH since. It makes the closure extremely easy.

Hi Samuel, that is an interesting input:

I have used V-Loc 180 for many years in e.g. hernia surgery, and am aware of that barbed sutures are popular for staple line reinforcement in bariatric surgery. Personally, I have been hesitant to use a permanent suture with multiple sharp points close to delicate structures suh as the esophageal wall.

You obviously have several years of experience. With how many cases? Have you never seen any long-term complications?

Dear Bengt, we have done over 200 repairs (either in primary paraesophageal hernias or closing of the Hiatus concomitantly with Bariatric surgery with no complications to date. we have submitted a couple of abstracts with smaller samples and currently working on a paper with all our experience with it. I also use it in Parastomal hernia repairs (see paper in my contributions to researchgate) and in Laparoscopic Ventral Hernias for over 3 years to close the fascia. very satisfy with the results. I wouldnt recommend its use to reinforce staple line in sleeve gastrectomy though, I feel that if you have a stenosis or narrow area during creation of the sleeve it's extremely difficult to remove, I recommend 2-0 Vycril for the same porpouse.

My preference is Ethibond 2/0 interrupted stitches.

Ethibond 2/0  or 3/0 with both intra coporial and some times extra corporial knots.

My preference is Ethibond 2-0 interrupted sutures and the first sticht to the pillars do extracorporeal knot GEA similar to Roeder, a slider with integrated Knot pusher court.

  This ensures I never fail in adjusting the first point, the rest with intracorporeal suture of the same material.

we close the crura with polypropelene 2/0

Silk suture 0 size to approximate the crura

Silk suture 2-0 size to make the fundal wrap around the esopgagus

Ethibond 2-0 is a strong and versatile suture allowing intra corporeal slipping of knots for good tension

2/0 prolene is my preference.

I use Ethibond. It is braided, no memory, very flexible and strong. Intracorporeal slip knots for suturing.

3 0 Ethibond and 3 interrupted sutures , 1 or 2 through the esophagus.Tried fig of 8 but not comfortabel .

www.Medtube.net prof pkreddy

Ethibond 2/0 extracorporeal with knot pusher

I use 2-0 ethibond sutures, intracorporeal, have performed 800+ so far

Prolene + Silk

I have always used interrupted 0 ethibond for suture cruroplasty as well as gastrogastric fundoplication. I use intracorporeal knot technique. In the past I have also tried continuous 0 V-loc for suture cruroplasty but discontinued it because of one recurrence.

2-0 ethibond

Thank you for your question.

We use 2/0 ethibond sutures.

The technique is described in detail in our publication-

We also anchor the fundus wrap to contain migration.

Please refer to our publication- Prof G. Falk & Dr T. D'Netto-

A Technique for the Laparoscopic Repair of Paraoesophageal Hernia Without Mesh, November 2013, Journal of Gastrointestinal Surgery 18(4)

DOI: 10.1007/s11605-013-2397-9

Source Pubmed

The technique and the rationale is described in the publication.

Hope this perspective helps.

Thanks Trevor