Please allow a few minutes for the web-page to download. This case presentation has11 pictures .

ESOPHAGO-GASTROPLASTY Drs. M.GAZAYERLI, Gandsas, Peralta and Silva are presenting a case of intractable esophageal stenosis due to a chronic esophagitis which was managed by a laparoscopic stricturoplasty of the Esophagus-Gastric junction (esophago-gastroplasty). This is a 77 year old male who has been suffering from chronic esophagitis due to advanced gastro-esophageal reflux disease (GERD) which resulted in dysphagia (inabilty to swollow solid foods). Because of the inflammatory process in the lower esophagus, scar tissue replaced the normal lining narrowing its lumen. The patient underwent repeated dilatations reliving him from his symptoms for less than a week each time. He was referred for surgical relief of the obstructive symptoms and reflux for which a laparoscopic esophago-gastroplasty with a Nissen fundoplication was performed. Although this procedure was very successful, we recommend that it should be reserved for patients whose only alternative would be a major open procedure with resection of the gastro esophageal junction and end-to-end anastomosis. This picture shows the anatomy of the esophageal-Gastric Junction before performing a gastrostomy. A gastrostomy is perfomed using the Harmonic scalpel and the disecction is continued on to the esophagus. This picture shows the esophageal-gastric junction opened. Note the stricture (scar-tissue) surrounding and narrowing the lower esophagus. An nasogastric tube is pushed into the stomach in order to identify both lumens. It is important to clamp the NG tube to avoid losing the pneumoperitoneum. Another view of the surgical field. Stay sutures have been placed to line up the opening before starting the closure. The material used was #"00" Ethibond (tm). Interrupted simple stiches are being placed. Care is taken to include the mucosa in each stich. Stiches are placed from both corners working towards the middle to reduce the tension at the suture line. The nasogastric tube is left in place during the closure . The closure has been completed. This shows the marked widening of the stricture area. The sutureline was tested under water, insuflating air through the nasogastric tube to the stomach. A Fundoplication Nissen was carried out to provide an anti-reflux mechanism. It was started high up at the level of the hiatus and covered the entire suture line. Pre (left) and Post-operative radiographic barium swollow studies.