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Laparoscopic total esophagogastric dissociation.

Julia Boubnova¹, Geraldine Hery, Fabrice Ughetto

¹Pediatric Surgery Department, Timone-Enfants, 13005 Marseille, France. julia.boubnova@gmail.com

Journal of Pediatric Surgery

|October 27, 2009

Summary

Total esophagogastric dissociation (Bianchi's procedure) offers a solution for severe gastroesophageal reflux when fundoplication fails. Laparoscopic total esophagogastric dissociation is feasible, even in patients with respiratory issues, though internal hernia remains a risk.

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Area of Science:

Gastroenterology and Surgical Procedures
Minimally Invasive Surgery Techniques

Background:

Severe gastroesophageal reflux refractory to fundoplication requires alternative surgical strategies.
Total esophagogastric dissociation (Bianchi's procedure) is an established option for complex reflux cases.
Laparoscopic surgery is increasingly utilized for its benefits in patients with comorbidities, including respiratory impairment.

Observation:

This report details two cases where total esophagogastric dissociation was successfully performed entirely laparoscopically.
A specific technique involving an intestinal clamp was employed to facilitate laparoscopic visualization of the proximal esojejunal anastomosis.
This clamp placement prevents esophageal retraction into the posterior mediastinum, ensuring surgical precision.

Findings:

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Laparoscopic total esophagogastric dissociation is a viable and effective approach for managing severe gastroesophageal reflux.
The described laparoscopic technique allows for safe and adequate examination of the critical esojejunal anastomosis.
No major intraoperative complications were noted in these two cases.

Implications:

Laparoscopic Bianchi's procedure expands treatment options for refractory gastroesophageal reflux, particularly in patients with respiratory compromise.
This minimally invasive approach may reduce patient recovery time and associated morbidity.
Awareness of potential complications, such as internal hernia, is crucial for postoperative management and patient counseling.