Endoscopic Assisted Laparoscopic Transgastric Division of a Gastroesophageal Fistula in an Adolescent

Video Type: CVideo
  • 2-5 min videos of a particular surgery or technique. These again show major events in the surgery
  • Clearly annotated and narration is a must in these videos
  • These have clear but concise abstracts are not able to be indexed in PubMed
  • Distributed in newsletters, featured on our website and social media
  • Peer reviewed

Author: Robert Vandewalle
Published:
Specialties: Endoscopy, Pediatric Surgery
Schools:
0 votes, average: 0.00 out of 50 votes, average: 0.00 out of 50 votes, average: 0.00 out of 50 votes, average: 0.00 out of 50 votes, average: 0.00 out of 5 (0 votes, average: 0.00 out of 5)
You need to be a registered member to rate this post.
Loading...
Basic Info

This video describes division of a gastroesophageal fistula in a 16 year old female with a history of prior Nissen fundoplication and gastrostomy tube placement as an infant. She presented to our clinic with progressive dysphagia and epigastric pain over a 2 month period. Initial attempts were made to divide the stapler using only a 12mm transgastric port at the prior gastrostomy site for the stapling device and an endoscope for visualization. Ultimately division required placement of an additional 5mm transgastric port for a laparoscope. Using both endoscopic and laparscopic visualization, the fistula was able to be divided using a standard laparoscopic stapler. At the completion of the procedure, the 5mm gastrotomy was closed and a gastrostomy tube was placed at the 12mm trocar site, which was then removed 2 months later. The patient's dypshagia improved after the procedure and her gastrostomy tube site closed without event.

Advanced

Procedure

Endoscopically assisted laparoscopic division of a gastroesophageal fistula in an adolescent

Indications

Benign gastroesophageal fistula

Contraindications

Concern for malignancy
Inability to safely place transgastric trocar
Inability to perform endosopy

Instrumentation

Setup

Supine positioning allowing for upper endocsopy; trocar placement typical for laparoscopic gastrostomy tube

Preoperative Workup

Upper Gastrointestinal Series
Upper endoscopy +/- biopsy if concern for malignancy

Anatomy and Landmarks

Endoscopy/Laparoscopic Identification of fistua and identification of tract during division

Advantages/Disadvantages

Advantages
-Improved visualization
-Decreased post-operative pain
-Improved cosmesis
Disadvantages
-Dual imaging requirement
-Coordination of visualization

Complications/Risks

Risks
-Gastric leak/requirement of gastrostomy tube
-Gastric/esophageal perforation

Disclosure of Conflicts

None

Acknowledgements

John Stroud and Paul Twomey-Erlanger AV department for their assistance in production

References

Share
0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply