Laparoscopic Heller Myotomy and Dor Fundoplication for Achalasia

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Author: Ciro Andolfi
Published:
Specialties: Gastrointestinal Surgery, General Surgery, Minimally Invasive
Schools: Harvard Medical School, University of Chicago
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Basic Info

Contributors: Marco P. Fisichella

Laparoscopic Heller myotomy and Dor fundoplication for a patient with type 2 achalasia.

DOI:  http://dx.doi.org/10.17797/seyyttx9lk

Advanced

Procedure

Laparoscopic Heller myotomy and Dor fundoplication

Indications

70 year Caucasian old man with daily dysphagia for liquids and solids for several years, worsening in the past year, non-cardiac chest pain and chronic dry cough while swallowing, but no heartburn or weight loss. Patient was diagnosed with type 2 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 degrees; 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 patient's legs, while first and second assistant stand on the right and left side respectively.

Preoperative Workup

EGD (normal), manometry (achalasia II), and barium swallow (bird's beak).

Anatomy and Landmarks

Excluding placement and removal of trocars, we can 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

There were no complications.

Disclosure of Conflicts

There are no conflicts of interest.

Acknowledgements

References

Andolfi C, Fisichella PM. Laparoscopic Heller Myotomy and Dor Fundoplication for Esophageal Achalasia: Technique and Perioperative Management. J Laparoendosc Adv Surg Tech A. 2016 Sep 8. [Epub ahead of print]. DOI: 10.1089/lap.2016.0407

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