Ruchir Puri, MD, Steven P Bowers, MD. Mayo Clinic, Florida.
The video submission is a case presentation of a 66 Y male who underwent a TIF (transoral incisionless fundoplication) complicated by mediastinitis. He developed severe, refractory dysphagia. He was found to have extensive fibrosis and thickening of the esophageal wall with extrinsic compression of the esophageal mucosa. Because of the finding of normal esophageal mucosa, the authors felt esophageal preservation was reasonable. After failing over thirty endoscopic dilatations and requiring parenteral nutritional support he consented to the operation. The video demonstrates mediastinal dissection in the setting of severe periesophageal fibrosis, at times limited visibility due to steam production and subsequent myotomy of the thickened fibrotic anterior esophageal wall. An omental patch was used to buttress the myotomy and separate the fibrotic edges. Intraoperative endoscopy was performed to ensure an adequate myotomy and a transgastric, jejunal feeding tube was placed for nutritional support. Postoperatively, swallowing was markedly improved and the patient returned to a regular diet. Endoscopy 6 weeks after the procedure showed a normal esophagus without residual stricture.
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