Double lumen esophagus: a rare complication of gastroesophageal reflux disease

Robotic Transgastric Reconstruction of the Double Lumen Esophagus

Double lumen esophagus is an extremely rare condition, developing in most cases as a complication of antireflux procedures or gastroesophageal reflux itself secondary to the severe inflammatory process in and around the lower esophagus. We describe a case of iatrogenic double lumen esophagus after multiple previous Nissen fundoplications for chronic gastroesophageal reflux disease. There is no standard surgical intervention for the management of this complication. We present a first report of successful robot-assisted surgical reconstruction of a double lumen esophagus.

Esophagogastric fistula associated with paraesophageal hernia in a 5-year-old girl

Esophagogastric fistula is a rare complication related to severe gastroesophageal reflux disease, previous surgery, or malignancy. We describe an unusual case of esophagogastric fistula associated with paraesophageal hernia in a 5-year-old girl. This is the first report in pediatric patients.

Laparoscopic transgastric gastroplasty: a novel technique for a large esophagogastric fistula

Esophagogastric fistula is a rare complication related to severe inflammation at the gastroesophageal junction. Most causes are related to severe gastroesophageal reflux disease, previous surgery, or malignancy. This is the case of a 72-year-old man who had a laparoscopic Nissen fundoplication. He developed an esophageal obstruction from an intraesophageal pledget. It was removed laparoscopically, and the esophagotomy was buttressed with a Nissen fundoplication. Two months later he developed severe dysphagia, and an esophagogastric fistula was diagnosed. This was a large fistula measuring 20 mm in diameter. A novel hybrid technique was used to divide the fundoplication. Under endoscopic guidance, a 12-mm balloon-tipped trocar was inserted transgastrically. A linear-cutting surgical stapler was used to divide the fundoplication and reopen the gastroesophageal junction. The patient had no further dysphagia or gastroesophageal reflux.