Assistive esophagoscopy during laparoscopic surgery for intra-thoracic stomach

Background: Intra-thoracic stomach (ITS) is a rare type of hiatal hernia. Laparoscopic surgery for ITS is technically demanding due to the distorted surgical anatomy. We incorporated assistive esophagoscopy during laparoscopic surgery for ITS. In this study, we assessed the clinical value of esophagoscopy in laparoscopic surgery. Methods: A retrospective data analysis of 11 consecutive patients with ITS was conducted. Laparoscopic surgery was conducted using a standard five-port technique, with the combination of carbon dioxide insufflating flexible esophagoscopy. The main indications for esophagoscopy were, (1) to demonstrate the course of esophagus and stomach during trans-hiatal mediastinal dissection, (2) to identify important anatomic landmarks, e.g., esophago-gastric junction, and (3) to calibrate the esophageal lumen during cruroplasty and/or fundoplication. Data included patient demographics, types of procedures, rate of conversion and/or complications, and surgical outcome. Results: Among 11 patients (9 females, 2 males, median age 75 years), 6 had gastric volvulus. Laparoscopic reduction of ITS with cruroplasty was completed in all cases without intraoperative complications. Six cases required prosthesis. Concomitant procedures were Nissen fundoplication in 9, Collis gastroplasty in 2, and sutured gastropexy in 5 cases. Flexible esophagoscopy enhanced the conduct and completion of these procedures, without any endoscopy-related complications. The median operation time was 247 min, and blood loss was minimal. The postoperative course was uneventful except for transient postoperative dysphagia in 2 cases. No relapse was noted within a median follow-up period of 11 months. Conclusions: Assistive intraoperative esophagoscopy facilitated laparoscopic surgery for ITS, suggesting it could potentially improve the surgical outcome by providing a better view during surgery.