Methods and instruments for treating gerd and hiatal hernia

Abstract

The invention relates to an intraluminar method of treating a reflux disease in a patient by implanting a device comprising an movement restriction device that, when implanted in a patient, fills a volume in the patient's abdomen that is close to and at least partially above the patient's cardia when the patient is in a standing position. The invention further relates to a method of restoring the location of the cardia in a patient suffering from a reflux disease and to an instrument suitable to use with intraluminar method and/or restoration method. Also disclosed are instruments treating a patient suffering hiatal hernia and providing a movement restriction device to be invaginated in the stomach fundus wall.

1 - 84 . (canceled) 
     
     
         85 . An apparatus for treating reflux disease of a human patient, the apparatus comprising an implantable movement restriction device having a size and shape adapted to be completely invaginated by the patient's stomach fundus wall without restricting a food passageway of the patient,
 wherein the outer surface of the movement restriction device is adapted to rest against the stomach fundus wall in a position between the patient's diaphragm and at least a portion of the invaginated stomach fundus wall, such that movement of the cardiac notch of the patient's stomach towards the patient's diaphragm is restricted, when the movement restriction device is invaginated, to thereby prevent the cardia from sliding through the patient's diaphragm opening into the patient's thorax,   the movement restriction device is further adapted to contact, directly or indirectly, the diaphragm muscle to prevent sliding of the cardia through the patient's diaphragm, so as to maintain a supporting pressure against the patient's cardia sphincter muscle exerted from the patient's abdomen.   
     
     
         86 . The apparatus according to  claim 85 , wherein the movement restriction device is non-adjustable from outside the patient's body when implanted in the patient. 
     
     
         87 . The apparatus according to  claim 85 , wherein the movement restriction device comprises a body, and wherein the body is at least one of: substantially egg shaped, substantially shaped like an egg with an indented middle section, substantially shaped like a bent egg, and shaped with rounded contours without too sharp edges that would be damaging to the patient's stomach wall. 
     
     
         88 . The apparatus according to  claim 85 , wherein the movement restriction device includes at least one of: an elastic outer wall, a flexible outer wall, and/or a solid body having rounded contours without sharp edges that would be damaging to the patient's stomach wall, and/or a solid body is made of a material softer than 15 shure. 
     
     
         89 . The apparatus according to  claim 85 , wherein the movement restriction device has a varying circumference so as to be better adapted to be kept invaginated in the stomach wall of the patient, the movement restriction device comprising at least one of the following shapes:
 a circumference in cross section, when moving along at least one axis through the movement restriction device, said axis having two end points, the circumference increases at least two times or decreases at least two times or having a larger circumference at the end points compared to a smallest circumference between the end points, when moving along said axis,   the movement restriction device having a circumference in cross section, when moving along an axis through the movement restriction device, that constantly increases or remains constant when moving along the axis from a first end point of said axis to a first intermediate point with a first maximum, that constantly decreases or remains constant when moving from the first intermediate point to a second intermediate point with a first minimum, that constantly increases or remains constant when moving along the axis from the second intermediate point of the axis to a third intermediate point with a second maximum; and that constantly decreases or remains constant when moving from the third intermediate point to a second end point of the axis, and   the movement restriction device having a maximum circumference in cross section, when moving along an axis through the body, that decreases or is constant when moving along the axis, when starting from the maximum circumference and moving in the one or two directions away from the maximum circumference along the axis.   
     
     
         90 . The apparatus according to  claim 85 , further comprising a first fixation device adapted to be in contact with the outside stomach wall and placed on the outside of the stomach to attach together portions of the fundus stomach wall to enclose and invaginate the movement restriction device to secure the movement restriction device in position, when the movement restriction device is implanted in the patient. 
     
     
         91 . The apparatus according to  claim 90 , wherein the first fixation device that is adapted to be in contact with the outside stomach wall comprises sutures or staples. 
     
     
         92 . The apparatus according to  claim 85 , wherein the movement restriction device is adapted to be placed on the outside of the stomach and further adapted to be invaginated by attaching together portions of the fundus stomach wall to enclose and invaginate the movement restriction device to secure the movement restriction device in said position. 
     
     
         93 . The apparatus according to  claim 85 , wherein the movement restriction device is adapted to be invaginated inside of the patient's stomach wall and invaginated from outside of the patient's stomach wall by attaching together portions of the fundus stomach wall from the outside of the patient's stomach wall. 
     
     
         94 . The apparatus according to  claim 85 , wherein the movement restriction device is adapted to be invaginated outside of the patient's stomach wall and invaginated from outside of the patient's stomach wall, by attaching together portions of the fundus stomach wall from outside of the patient's stomach wall. 
     
     
         95 . The apparatus according to  claim 85 , wherein the movement restriction device comprises an implantable first fixation device integrated in the movement restriction device and protruding at a point of the movement restriction device in a direction of a normal of that point of the movement restriction device, and wherein the movement restriction device is adapted to be directly or indirectly secured to the patient's esophagus, without fixation of the diaphragm muscle, thus allowing breathing movements of the diaphragm in relation to the stomach and the esophagus, while preventing the sliding of the cardia through the patient's diaphragm by keeping the movement restriction device secured to the esophagus in said position, when the movement restriction device is implanted. 
     
     
         96 . The apparatus according to  claim 85 , wherein the movement restriction device is provided with a coating. 
     
     
         97 . The apparatus according to  claim 96 , wherein the coating comprises Parylene. 
     
     
         98 . The apparatus according to  claim 95 , wherein the first fixation device comprises a tissue growth promoting structure adapted for long term attachment of the movement restriction device to the stomach wall without invagination 
     
     
         99 . The apparatus according to  claim 98 , wherein the tissue growth promoting structure comprises a net like structure. 
     
     
         100 . The apparatus according to  claim 99 , wherein the tissue growth promoting structure further comprises sutures or staples that, when implanted in the patient, are adapted to attach the net like structure to the fundus stomach wall. 
     
     
         101 . The apparatus according to  claim 95 , wherein the first fixation device is adapted to attach together portions of the fundus stomach wall that enclose the movement restriction device to secure and invaginate the movement restriction device in said position against the stomach fundus wall. 
     
     
         102 . The apparatus according to  claim 101 , wherein the first fixation device comprises sutures or staples, which when implanted in the patient are adapted to attach together portions of the fundus stomach wall, to thereby keep the movement restriction device in place. 
     
     
         103 . The apparatus according to  claim 102 , wherein the movement restriction device is adapted to be invaginated in at least a portion of the fundus stomach wall from inside of the patient's stomach wall. 
     
     
         104 . The apparatus according to  claim 102 , wherein the movement restriction device is adapted to be invaginated in at least a portion of the fundus stomach wall from outside of the patient's stomach wall.