Apparatus and method for securing the stomach to the diaphragm for use, for example, in treating hiatal hernias and gastroesophageal reflux disease
A patient's stomach may be secured to the patient's diaphragm. A method to accomplish this includes visualizing a wall of a patient's stomach adjacent the patient's diaphragm from within the patient's stomach, inserting a fastener deployment apparatus down the patient's esophagus and into the mammalian's stomach, and fastening the patient's stomach to the patient's diaphragm with the fastener deployment apparatus and from within the stomach. The procedure may be employed to advantage to treat a hiatal hernia, for example, either alone or in conjunction with the restoration of the patient's gastroesophageal flap valve.
1. An assembly for repairing a hiatal hernia, comprising:
an elongated member including a proximal end and a distal end;
a plurality of orifices on the elongated member configured to pull a vacuum to grip the inner wall of an esophagus;
after gripping the esophagus, the elongated member is configured to be moved aborally toward a stomach to position the stomach and a gastroesophageal junction aboral of the diaphragm;
a fastener deployer, the elongated member and the fastener deployer being configured to advance the fastener deployer down a throat and esophagus into a stomach, the fastener deployer being further arranged to fasten a lesser curve of the stomach to a right crus of the diaphragm;
a support arm pivotally attached to the distal end of the elongated member and configured for supporting the fastener deployer in close proximity to the fundus of the stomach;
a visualization device that enables visualization of the lesser curve of the stomach being fastened to the right crus of the diaphragm;
wherein the fastener deployer includes at least one fastener to be deployed, the fastener comprising a first member, a second member, the first and second members having first and second ends;
a connecting member fixed to each of the first and second members intermediate the first and second ends and extending between the first and second members, wherein the first and second members are separated by the connecting member, the connecting member having sufficient length to pass through both the right crus of the diaphragm and the lesser curve of the stomach wherein the first member has a through channel along a longitudinal axis arranged to be slidingly received on a tissue piercing deployment wire; and
wherein the first member has a longitudinal slit that can be made larger through separation to allow a deployment wire to snap into and out of the through channel.
2. The assembly of claim 1 , wherein the fastener deployer comprises a guide tube supported by the support arm that positions the fastener deployer spaced away from the esophageal opening to the stomach.
3. The assembly of claim 1 , wherein the visualization device comprises an endoscope.
4. The assembly of claim 1 , wherein the elongated member includes a guide that guides the visualization device into the stomach.
5. The assembly of claim 1 , wherein the deployment wire arranged to be slidingly received by the through channel of the first member has a sharp tip to pierce into the tissue to be fastened, and to guide the fastener into the tissue.
6. The assembly of claim 5 , wherein the fastener deployer further comprises a pusher that pushes the one of first and second members into the tissue while on the deployment wire.
7. The assembly of claim 5 , wherein the fastener deployer further comprises a guide tube extending over the deployment wire and the fastener that guides the deployment wire and fastener to the tissue.