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Laparoscopic Trans-Hiatal Esophagectomy for End-Stage Achalasia
Brandon Peine1, Carlos Anciano2, Aundrea Oliver2, Mark Iannettoni2, James Speicher2.
1Department of Surgery - East Carolina University, Greenville, NC, USA, 2East Carolina Heart Institute at East Carolina University, Greenville, NC, USA.

OBJECTIVE: Trans-hiatal esophagectomy is the treatment of choice for patients with end-stage achalasia as it allows for resection of a greater length of diseased esophagus as compared with other methods for esophagectomy. Our aim with this video is to demonstrate the key steps and efficacy of minimally-invasive trans-hiatal esophagectomy for the treatment of end-stage achalasia as an alternative to the traditional open trans-hiatal esophagectomy.
METHODS: Our patient is an 18-year old African-American woman with type II achalasia who presented with symptoms of chest pain and food impaction. She initially underwent a POEM procedure but had early recurrent symptoms requiring multiple endoscopic procedures over the next 2 years. She also underwent a Dor fundoplication to treat her reflux. Despite frequent interventions she continued to have severe dysphagia. She was brought to the operating room for definitive treatment with a laparoscopic trans-hiatal esophagectomy.
RESULTS: Our video demonstrates the key steps of the minimally-invasive trans-hiatal esophagectomy, including the mobilization of the stomach and duodenum, the careful preservation of the right gastroepiploic artery, the esophageal mediastinal dissection, the creation of the gastric conduit, and the cervical esophagogastric anastomosis.
CONCLUSIONS: The key steps of the minimally-invasive trans-hiatal esophagectomy are demonstrated in this video. This procedure is a safe and effective alternative to the traditional open trans-hiatal esophagectomy.


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