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
Specialties: Endoscopy, Pediatric Surgery
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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.



Endoscopically assisted laparoscopic division of a gastroesophageal fistula in an adolescent


Benign gastroesophageal fistula


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



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


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


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

Disclosure of Conflicts



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


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