Laparoscopic Heller procedure for achalasia developed late after esophageal reconstruction for atresia

This is a case of a 30-year-old male patient with a childhood history of surgical repair of esophageal atresia, who in his third decade of life developed a gradual dysphagia accompanied by severe respiratory symptoms due to aspiration. The diagnostic work-up revealed an achalasia. A laparoscopic Heller myotomy completed with a Dor fundoplication was performed.

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Laparoscopic Heller procedure for achalasia developed late after esophageal reconstruction for atresia

Authors

F Marinello, EM Targarona, S Mocanu, S Fernandez Ananin, Luis Pallarés, M Trías

Abstract

This is a case of a 30-year-old male patient with a childhood history of surgical repair of esophageal atresia, who in his third decade of life developed a gradual dysphagia accompanied by severe respiratory symptoms due to aspiration. The diagnostic work-up revealed an achalasia. A laparoscopic Heller myotomy completed with a Dor fundoplication was performed.

Catégorie

contribution

Mots-clés

Laparoscopic Heller procedure, achalasia, esophageal reconstruction, atresia

Type de vidéo

Vidéo chirurgicale

Durée

06'53''

Publication

2011-12

Popularité

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E-publication

WeBSurg.com, Dec 2011;11(12).
URL: http://www.websurg.com/doi-vd01en3521.htm

Laparoscopic Heller procedure for achalasia developed late after esophageal reconstruction for atresia

1. Clinical case presentation 00'18''

This is the case of a 30-year-old patient with a past history of esophageal atresia and tracheoesophageal fistula requiring esophagoplasty and right bilobectomy at the age of 10. In the last ten years, the patient presented severe dysphagia with regurgitation and recurrent aspiration pneumonia with a severely deteriorated quality of life (GIQLI score 104).

2. Preoperative study 00'40''

Esophagogram showed esophageal dilatation with dysmotility of the middle third of the esophagus and delayed emptying. Thoracic CT-scan demonstrated esophageal dilatation and bronchiectasis with cavitation in the upper right lobe. Endoscopy showed esophageal dilatation and anastomosis situated at 25cm from the dental arcades without stenosis. Manometry showed simultaneous non-propulsive esophageal waves with generalized hypotonia of the esophageal body, as well as incomplete relaxation of the inferior esophageal sphincter with swallowing, along with normal sphincteric pressures.

3. Approach 02'28''

The final diagnosis was achalasia and a laparoscopic Heller procedure was proposed. The procedure starts with the exposure of the hiatal region and access to the inferior thoracic esophagus.

4. Myotomy and submucosal dissection 02'48''

An anterior longitudinal myotomy is made on the esophagus and the submucosal plane is developed using blunt dissection, until bulging of the mucosa is observed.

5. Endoscopic control 04'32''

Endoscopic control is performed with air insufflation and trans-illumination to assure the complete sphincteric section and discard mucosal tears.

6. Fundoplication 05'34''

The intervention ends with an anterior Dor fundoplication, overlapping the exposed mucosa with the anterior gastric fundus anchored to the diaphragmatic crura and including bites of muscular layer in the non-absorbable sutures.

7. Postoperative evaluation 06'46''

The postoperative gastrografin swallow test showed correct contrast propulsion to the stomach.