VA03.2. Management of Sigmoid Esophagus in Achalasia: Laparothoracoscopic Ivor Lewis Esophagectomy

Abstract

Benign Disease: Esophageal Function and Motility Video Description This video demonstrates laparothoracoscopic Ivor Lewis esophagectomy for end-stage achalasia cardia with sigmoid esophagus. The procedure includes abdominal and thoracic phases, gastric conduit preparation, esophageal mobilization, resection of the sigmoidized esophagus, and intrathoracic esophagogastric anastomosis. Key technical steps, patient positioning, port placement, and intraoperative challenges unique to sigmoid esophagus are highlighted. Sigmoid esophagus represents end-stage achalasia, where conventional treatments such as myotomy or endoscopic interventions are ineffective. Esophagectomy remains the definitive option but is technically demanding due to distorted anatomy, mediastinal fibrosis, and dilated esophagus. This video demonstrates a minimally invasive laparothoracoscopic Ivor Lewis approach, offering effective symptom relief while avoiding thoracotomy. The technique is infrequently showcased and provides valuable insights into decision-making and operative strategies for complex achalasia cases.