Laparoscopic Heller Myotomy and Anterior Partial Fundoplication

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: Ciro Andolfi
Published:
Specialties: Gastrointestinal Surgery, General Surgery, Minimally Invasive
Schools: University of Chicago
1 vote, average: 5.00 out of 51 vote, average: 5.00 out of 51 vote, average: 5.00 out of 51 vote, average: 5.00 out of 51 vote, average: 5.00 out of 5 (1 votes, average: 5.00 out of 5)
You need to be a registered member to rate this post.
Loading...
Basic Info

Contributors: Marco G. Patti

Laparoscopic Heller Myotomy and Anterior Partial Fundoplication

DOI: http://dx.doi.org/10.17797/m5v0f8xzp3

Advanced

Procedure

Laparoscopic Heller Myotomy and Anterior Partial Fundoplication

Indications

Severe symptoms and diagnosis of achalasia

Contraindications

There were no contraindications.

Instrumentation

Setup

The patient lies supine on the operating table in low lithotomy position with the lower extremities extended on stirrups with knees flexed 20-30°; a bean bag is inflated to avoid sliding of the patient; if possible an orogastric tube is placed to decompress the stomach; the surgeon stands between the patients legs, while first and second assistant stand on the right and left side respectively. A five trocar technique is used for this procedure; a first trocar is placed 14 cm inferior to the xiphoid process, in the midline, for a 30�° scope; a second trocar is placed in the left midclavicular line, at the same level with the first trocar, to introduce a Babcock clamp; a third trocar is placed in the right midclavicular line, at the same level of the other two trocars, and it is used for the insertion of a retractor to lift the liver; a fourth and a fifth trocar are placed under the right and left costal margins and they are used for the dissecting and suturing instruments.

Preoperative Workup

1) upper endoscopy, which showed retained food in the esophagus; 2) barium swallow, which showed distal esophageal narrowing with an air-fluid level; 3) esophageal manometry, which showed type II achalasia.

Anatomy and Landmarks

We consider five steps for this operation.
1. Division of the gastro-hepatic ligament; identification of the right crus of the diaphragm and posterior vagus nerve.
2. Division of the peritoneum and phreno-esophageal membrane above the esophagus; identification of the left crus of the diaphragm and anterior vagus nerve.
3. Division of the short gastric vessels.
4. Esophageal myotomy.
5. Dor fundoplication.

Advantages/Disadvantages

Complications/Risks

The postoperative course was uneventful.

Disclosure of Conflicts

The postoperative course was uneventful.

Acknowledgements

References

Share
0 replies

Leave a Reply

Want to join the discussion?
Feel free to contribute!

Leave a Reply