Edward D Auyang, MD MS, Brant K Oelschlager, MD. Department of Surgery, University of Washington
Impaired emptying of the gastric conduit or neoesophagus after esophagectomy can have multiple etiologies including decreased motility secondary to vagus nerve damage and mechanical stricturing. Often times, these etiologies can be managed with pro-motility medications, dilation, and pyloroplasty. The patient with a mechanical obstruction who is refractory to these treatments presents a unique challenge. Few options exist other than replacement of the neoesophagus with a colonic interposition graft. In this video, we demonstrate a laparoscopic gastroduodenostomy as a potential operative solution to the problem of impaired gastric emptying after esophagectomy.
Laparoscopic gastroduodenostomy was performed in a 65 year old patient with a history of previous Ivor-Lewis esophagectomy for caustic ingestion 25 years prior. She had a pyloroplasty as part of her initial operation, but has had chronic dysphagia and vomiting despite medical treatments and repeated endoscopic dilations. A gastroduodenostomy across the pylorus was performed completely laparoscopically in conjunction with an intraoperative upper endoscopy to create a wide-mouthed gastroduodenal anastomosis. At the completion of the operation, an upper endoscopy was repeated to confirm widening of the pylorus and absence of anastomotic leak.
The operation was completed in 3 hours and 30 minutes with minimal blood loss and no complications. The patient was discharged home on post-operative day #4 on a soft diet.
Laparoscopic gastroduodenostomy is a feasible operation for patients who have had a previous esophagectomy with impaired gastric conduit emptying and are refractory to other medical and interventional treatments.
Session Number: SS21 – Videos: Solid Organ & Foregut
Program Number: V040