485 views

Endoscopic Assisted Laparoscopic Transgastric Division of a Gastroesophageal Fistula in an Adolescent

This video describes division of a gastroesophageal fistula in a 16 year old female with a history of prior Nissen fundoplication and gastrostomy tube placement as an infant. She presented to our clinic with progressive dysphagia and epigastric pain over a 2 month period. Initial attempts were made to divide the stapler using only a 12mm transgastric port at the prior gastrostomy site for the stapling device and an endoscope for visualization. Ultimately division required placement of an additional 5mm transgastric port for a laparoscope. Using both endoscopic and laparscopic visualization, the fistula was able to be divided using a standard laparoscopic stapler. At the completion of the procedure, the 5mm gastrotomy was closed and a gastrostomy tube was placed at the 12mm trocar site, which was then removed 2 months later. The patient’s dypshagia improved after the procedure and her gastrostomy tube site closed without event.

Endoscopically assisted laparoscopic division of a gastroesophageal fistula in an adolescent
Benign gastroesophageal fistula
Concern for malignancy Inability to safely place transgastric trocar Inability to perform endosopy
Supine positioning allowing for upper endocsopy; trocar placement typical for laparoscopic gastrostomy tube
Upper Gastrointestinal Series Upper endoscopy +/- biopsy if concern for malignancy
Endoscopy/Laparoscopic Identification of fistua and identification of tract during division
Advantages -Improved visualization -Decreased post-operative pain -Improved cosmesis Disadvantages -Dual imaging requirement -Coordination of visualization
Risks -Gastric leak/requirement of gastrostomy tube -Gastric/esophageal perforation
None
John Stroud and Paul Twomey-Erlanger AV department for their assistance in production
N/A

Review Endoscopic Assisted Laparoscopic Transgastric Division of a Gastroesophageal Fistula in an Adolescent.

Your email address will not be published. Required fields are marked *

Related Videos

Register today to continue watching

Sign up for our free membership to watch and submit videos today! If you are already a member please log in to access your account.

Sign Up Now

Already a member? Click here to log in

Register today to submit a video

Sign up for our free membership to watch and submit videos today! If you are already a member please log in to access your account.

Sign Up Now

Already a member? Click here to log in

Upgrade your membership to continue watching

Please upgrade to membership to continue watching more videos.

Upgrade Now

Renew your subscription to continue watching

Please renew your subscription to continue watching.

Renew Now

Create An Author

Create A User

Create A Term