Coronal views of a dilated esophagus with excessive retained food, secondary to achalasia.
The braided suture is snared by the endoscopist and will be drawn back through the esophagus to exit through the mouth.
A. The endoscope is advanced down the relatively straight esophagus until the lower esophageal sphincter is identified. B. The lower esophageal sphincter often coincides with the transition from squamous epithelium (white) of the esophagus to mucosa (pink
Dissection posterior to the esophagus within the mediastinum.
A. Placement of Babcock clamp on the posterior fundus in preparation for passing it behind the esophagus to create the posterior or right lip of the fundoplication. To achieve the proper angle for passage, place the Babcock through the left lower trocar.
A. Three to six interrupted 0-gauge silk sutures are used to close the crura. B. Exposure of the crura and posterior aspect of the esophagus is facilitated by traction on a Penrose drain encircling the gastroesophageal junction.