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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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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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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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