title: A novel laparoscopic approach for severe esophageal stenosis due to reflux esophagitis: how to do it.
abstract: We herein report our technique for laparoscopic esophageal myotomy combined with Collis gastroplasty and Nissen fundoplication for severe esophageal stenosis. Our patient had experienced vomiting since childhood, and his dysphagia had gradually worsened. He was referred to our department for surgery because of resistance to pneumatic dilation. He was diagnosed with a short esophagus based on the findings of a preoperative upper gastrointestinal series and GI endoscopy. After exposing the abdominal esophagus, esophageal myotomy around the esophago-gastric junction (EGJ) was undertaken to introduce an esophageal bougie into the stomach. Then, stapled wedge gastroplasty was performed, and a short and loose Nissen fundoplication was performed. In addition, the bulging mucosa after myotomy was patched using the Dor method. The patient's postoperative course was uneventful. Most patients with esophageal stricture require subtotal esophagectomy. Laparoscopic surgery for patients with benign esophageal stricture refractory to repeated pneumatic dilation is challenging. However, our current procedure might abrogate the need for invasive esophagectomy for the surgical management of severe esophageal stenosis.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan, kazuto@jikei.ac.jp.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Omura
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yano
authors.forename: Masato
authors.initials: M
authors.lastname: Hoshino
authors.forename: Se Ryung
authors.initials: SR
authors.lastname: Yamamoto
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Akimoto
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kashiwagi
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000293:Adolescent; D049630:Esophageal Sphincter, Lower / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology* / Q000601:surgery*; D004942:Esophagitis, Peptic / Q000150:complications*; D004947:Esophagus / Q000601:surgery*; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012720:Severity of Illness Index; D016896:Treatment Outcome