793. MODIFIED HELLER DOR FOR ACHALASIA

Abstract Introduction Achalasia is an esophageal disorder that involves a failure in the relaxation of the lower esophageal sphincter, which leads to dysphagia and other symptoms. The objective of the present study is to report the surgical technique performed in a patient with achalasia, in which the Heller myotomy technique was performed together with Dor fundoplication. Method The technique performed was a modified Heller-Dor with long myotomy Surgical intervention began with the introduction of the trocars plus pneumoperitoneum, a narrow of distal esohagus and enlargement of the diaphragmatic crura, mas found. Continuing with dissection of the esophageal hiatus with ultrasonic forceps, release of phreno-esophageal membrane. The esophagus was elongated in the mediastinum and brought 7 centimeters to the abdomen. After that, there was approximation of the diaphragmatic crura with 1 point of Ethibond 2-0. Following the dissection of the eophagogastric junction and identification of the posterior and anterior vagus nerve, releasing the “fat pad” for correct identification of the esophagogastric junction. So, the myotomy in the esophagus 6 centimeters above the cardia and 3 centimeters below, was performed. Follow, the gastric fundus was sutured to the anterior border of the esophagus and left diaphragmatic pillar with 2-0 Ethibond, until the esophagus gastric junction in running suture. The anterior suture, covering the myotomy the edge of the muscular layer of the esophagus as the same way. Conclusion Finally, with regard to the treatment of achalasia, Heller cardiomyotomy plus Dor fundoplication, has been shown to be efficient for improvement of dysphagia symptoms and to avoid symptoms related to emergence of reflux after myotomy. https://drive.google.com/file/d/176L7Jo0tFMylWvhsgtscESHHFbOONl4A/view?usp=sharing