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surgical intervention video

Type IV hiatal hernias are infrequent and challenging. They are characterized by a migration of the omentum, stomach, colon, spleen, and/or pancreas towards the mediastinum. Surgical repair requires hernia sac resection, content reduction, tension-free repair, and Nissen fundoplication. The use of mesh to reinforce closure may be considered to reduce the recurrence rate after laparoscopic treatment of such hernias, especially when the hiatus is wide and has little compliance. 

Laparoscopic repair of type IV hiatal hernia with mesh

Cure laparoscopique d'une hernie hiatale de type IV avec pose de prothèse

Achalasia is a neurodegenerative motility disorder of the esophagus resulting in deranged esophageal peristalsis and loss of lower esophageal sphincter (LES) function. We present the case of a 63-year-old female patient who was referred to our hospital for vomiting and dysphagia. Esophageal dilatation and abnormal food and fluid retention were observed on endoscopy. The patient had a nasogastric tube placed for 3 months for enteral nutrition. The patient underwent esophageal dilatation once or twice. Due to the sigmoid esophagus, we decided to perform an esophagectomy and tubularized gastric pull-up by combining thoracoscopy, laparoscopy, and cervicotomy. In addition, we replaced the nasogastric tube to provide sufficient and early nutritional support. The patient started feeding on postoperative day 4 and she is currently asymptomatic. 

Thoracolaparoscopic three-stage esophagectomy for advanced megaesophagus (chagasic achalasia) with gastric tube pull-up

Œsophagectomie thoracolaparoscopique en trois étapes pour un mégaœsophage avancé (achalasie chagasique) avec remontée de la sonde gastrique

Œsophagectomie : approche thoracoscopique  en position couchée

The treatment of esophageal cancer has evolved at a rapid pace in recent decades. It was focused on a multimodal multidisciplinary approach, including chemoradiation therapy and surgery, as its main tools. Likewise, minimally invasive surgery has become the approach of choice for this pathology in many centers worldwide. For its part, the need to optimize the extension of mediastinal lymphadenectomy as another essential tool for the locoregional control of the disease has made thoracoscopy a safe and efficient approach for this purpose. This is the clinical case of a 35-year-old woman smoker, with symptoms of dysphagia and regurgitation with a 5-month evolution, associated with weight loss greater than 20kg. Fibrogastroscopy (FGS) and computed tomography were performed, which confirmed the presence of a squamous cell carcinoma of the middle thoracic esophagus. Distant disease was ruled out, and it was decided to perform neoadjuvant chemoradiation therapy. After it was completed and the disease restaged, the authors performed a triple approach thoracolaparoscopic esophagectomy, with an almost total mediastinal lymphadenectomy, which is the subject of this video. 

Thoracoscopic approach for esophagectomy in prone position

This video demonstrates an esophagectomy performed laparoscopically and thoracoscopically in a 41-year-old female patient presenting with esophageal adenocarcinoma. During the abdominal phase, the gastric tube was created, and in the thoracic phase, the stages of the intrathoracic esophagogastric anastomosis are shown in a stepwise fashion. The video highlights the preservation of the thoracic duct, as well as mediastinal lymphadenectomy. 

Focus on Upper GI / Esophageal surgery

Laparoscopic repair of type IV hiatal hernia with mesh

Thoracolaparoscopic three-stage esophagectomy for advanced megaesophagus (chagasic achalasia) with gastric tube pull-up

Thoracoscopic approach for esophagectomy in prone position

Laparoscopic and thoracoscopic Ivor-Lewis esophagectomy