c l i n i c a l f o l i o s : n a r r a t i v e





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Laparoscopic Heller Esophagomyotomy: 1

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A 50-year-old woman with dysphagia had demonstrated achalasia by esophageal manometry. She was taken to the operating room for a laparoscopic esophagomyotomy and fundoplication. The esophagus was exposed (see laparoscopic Nissen fundoplication) and mobilized up into the mediastinum.    

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Laparoscopic Heller Esophagomyotomy: 2

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The mediastinal mobilization was extended to allow a 6 cm esophageal myotomy. The landmark for the myotomy in an open procedure is the left inferior pulmonary vein.     

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Laparoscopic Heller Esophagomyotomy: 3

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The myotomy was started at the gastroesophageal junction by lifting the muscular layers with a hook cautery. The left (anterior) vagal trunk was identified and preserved.     

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This page was last modified on 2/18/2003.