Aarthy Kannappan, MD, Manuel Garcia, MD, Esther Wu, Jeffrey Quigley, MD, Stephanie Keeth, DNP, Marcos Michelotti, MD, FACS, Keith Scharf, Crystal Alvarez, DO. Loma Linda University
Presented is a video case report of a 44-year-old male who presented with persistent difficulty swallowing liquids and solids approximately 7 months after a laparoscopic Heller myotomy at an outside institution. Pre-operative UGI showed persistent achalasia. The patient underwent a Robotic Re-do Heller myotomy with the aid of fluorescence. Post-operative UGI showed complete resolution of the achalasia. He was discharged home without complications. Minimally invasive Heller myotomy is considered the optimal treatment for patients with achalasia. However, approximately 10-20 % of patients fail this treatment and require re-operation. The most common cause for this is incomplete gastric myotomy. Robotic assisted re-do Heller myotomy is a safe and effective procedure for these patients. Fluorescent technology can be very useful in identifying the appropriate planes of dissection, and avoiding mucosal injury during these procedures. In our case, we used multiple modes of fluorescence, including a 52 Fr lighted bougie, and the firefly mode of the Da Vinci robot. These enhancements allowed for a safe and complete dissection. Resolution of dysphagia is achieved after these procedures.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87946
Program Number: V092
Presentation Session: Thursday Exhibit Hall Theater (Non CME)
Presentation Type: EHVideo