PMC3113175_01
The gastroscope is retroflexed, and part of the stomach is visualized herniating through the hiatus.
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F1
An upper gastrointestinal endoscopy and an upper gastrointestinal series revealed a type III hiatal hernia (Figure 1).
Puncture of the gastric wall under direct vision through the laparoscope.
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F2
Under laparoscopic and gastroscopic visualization, a needle with a sheath was inserted into the stomach (Figures 2 and 3); a wire was passed through the sheath and grasped with a snare placed through the endoscope.
The needle is observed entering the gastric lumen; the transillumination of the laparoscope light is visible through the wall of the stomach.
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F3
Under laparoscopic and gastroscopic visualization, a needle with a sheath was inserted into the stomach (Figures 2 and 3); a wire was passed through the sheath and grasped with a snare placed through the endoscope.
The stomach and the anterior abdominal wall are in apposition.
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F4
The gastric and anterior abdominal wall were apposed without tension (Figure 4); the position of the mushroom appeared satisfactory through the gastroscope, and the catheter was secured in place.