PMC5480277_01
Barium swallow showing normal deglutition, Dilated smooth esophagus with a smooth stenosis at the EG junction. Retained food in the esophagus with slow passage of contrast into esophagus with decreased peristalsis. Findings consistent with achalasia.
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The patient underwent a barium swallow to confirm diagnosis and evaluate position of GE junction (Fig. 1).
High resolution esophageal manometry showing low LES pressures and aperistalsis. Mean LES pressure: 5 mmHg (abnormal <15%), LES Percent Relaxation: 56%, Percent Failed Propulsive Swallows: 100%, and Contraction Amplitudes: <20% (very low).
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In addition the patient had a high resolution manometry study to confirm aperistalsis and assist in creating a tailored operative approach to address her symptoms (Fig. 2).
Courtesy of DaVinci Online Community. Standard Procedure Card for foregut surgery. For our Robotic Dor Fundoplication Camera port, Port 2 and Port 1 were used. Port B was used for a Nathanson liver retractor. The Assistant Port A and Port 3 were not used.
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After informed consent was obtained, the patient underwent a Robotic Dor Fundoplication to alleviate the gastroesophageal reflux and prevent long-term complications with dysphagia (Fig. 3).
Intraoperative endoscopy showing no evidence of injury to esophagus, no evidence of narrowing at GE junction. Shown here is a retroflex view with GE junction valve consistent with fundoplication.
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Intraoperative endoscopy was performed to evaluate the wrap (Fig. 4).