title: Laparoscopic transgastric gastroplasty: a novel technique for a large esophagogastric fistula.
abstract: Esophagogastric fistula is a rare complication related to severe inflammation at the gastroesophageal junction. Most causes are related to severe gastroesophageal reflux disease, previous surgery, or malignancy. This is the case of a 72-year-old man who had a laparoscopic Nissen fundoplication. He developed an esophageal obstruction from an intraesophageal pledget. It was removed laparoscopically, and the esophagotomy was buttressed with a Nissen fundoplication. Two months later he developed severe dysphagia, and an esophagogastric fistula was diagnosed. This was a large fistula measuring 20 mm in diameter. A novel hybrid technique was used to divide the fundoplication. Under endoscopic guidance, a 12-mm balloon-tipped trocar was inserted transgastrically. A linear-cutting surgical stapler was used to divide the fundoplication and reopen the gastroesophageal junction. The patient had no further dysphagia or gastroesophageal reflux.
authors.affiliation: Department of Surgery, Indiana University School of Medicine , Indianapolis, Indiana.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: McKenna
authors.forename: Kathryn
authors.initials: K
authors.lastname: Ziegler
authors.forename: Don
authors.initials: D
authors.lastname: Selzer
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology; D004943:Esophagogastric Junction / Q000601:surgery; D018662:Fundoplication / Q000009:adverse effects; D005747:Gastric Fistula / Q000209:etiology / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000209:etiology; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012086:Reoperation; D015607:Stents / Q000009:adverse effects