S Velmurugan, HOD of GI and Lap Surgery, R Archana, B Kasi Viswanath. kauvery hospital, Trichy, India
62 year old male presented with dysphagia, cough, loss of weight and appetite. There was history of recurrent pneumonitis due to repeated aspiration. He was diagnosed to have achalasia cardia few years before this presentation. He had already undergone laparoscopic Heller’s Cardiomyotomy, which relieved his dysphagia for few years. Then he had endoscopic balloon dilatation for recurrent achalasia, which helped him only temporarily. His endoscopy and imaging showed end stage achalasia with evidence of recurrent aspiration.
After informed consent, thoraco – laparoscopic oesophagectomy was performed. Intra operative finding was mega oesophagus measuring about 8 cm diameter filled with food residue. There were lung adhesions in right hemithorax.
Procedure:
THORAX – Prone position. Single lung ventilation. Two 10 mm ports and two 5mm ports used. Lung adhesions carefully released. Azygous vein ligated. Inferior pulmonary ligament divided. Entire length of intrathoracic oesophagus mobilized with Harmonic scalpel. Haemostasis checked. Chest drain inserted.
ABDOMEN – One 10-12mm port, one 10mm port and three 5mm ports used. Adhesions from previous surgery released. Laparoscopic mobilisation of stomach based on right gastro-epiploic and right gastric vessels performed.. Hiatal dissection done and lower oesophagus freed. Left gastric vessels ligated and divided. Mini upper midline incision made. Gastric conduit fashioned with stapler. Pyloromyotomy done.
NECK – Oblique incision. Deep fascia opened. Muscles retracted. Oesophagus slung and oesophagectomy done. Gastric conduit delivered into neck. Oesophago-gastric (side to side) anastomosis was done with stapler. Stapler entry site sutured in two layers with 3-0 PDS. Ryles tube passed through into stomach.
Feeding jejunostomy done.
On 8th postoperative day, he aspirated. He needed non invasive respiratory support. Later tracheostomy was performed. He slowly recovered from his aspiration pneumonitis and tracheostomy tube was removed. Further recovery was uneventful. On follow up, there was no dysphagia and he gained weight.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95863
Program Number: V291
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop