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Laparoscopic Heller’s Esophago-myotomy for Achalasia Cardia in Pediatric Patients
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Once the myotomy is complete the process for reconstructing the GE junction is done. This starts with narrowing the wide esophageal hiatus. The right and the left crura are approximated to make it a snug fit for the esophagus. The upper end of myotomy is anchored to the crural stitches to ensure the length of intra-abdominal esophagus is maintained.
Keywords
- esophageal hiatus
- intra-abdominal esophagus
Conflict of Interest
The author declares no conflict of interest.
About this video
- Author(s)
- Ravi P. Kanojia
- First online
- 30 September 2020
- DOI
- https://doi.org/10.1007/978-981-15-9596-7_7
- Online ISBN
- 978-981-15-9596-7
- Publisher
- Springer, Singapore
- Copyright information
- © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2020
Video Transcript
So our next step is the crural repair. We are now starting with the reconstruction of the GE junction and creating the anterior-flex mechanism, which starts with the repair in the approximation of the esophagus. The first bite in the esophagus starts with a small bite in the upper end of the myocardial region so that the entire myocardial stays within the abdominal side of the diaphragm and is covered by the fundoplication flap.
So this stitch is going to make sure that whatever esophageal length you have pulled inside the abdomen will stay inside the abdomen, and it will not end up inside the mediastinum. The crural repair should be snug enough to close the entire diameter of the esophagus, and you have to make sure that it should not be tight. And the presence of bougie is going to help you to decide how tight of a crural repair you should do.