Peroral endoscopic myotomy and valve section for treatment of persistent and disabling dysphagia after laparoscopic fundoplication (with video)

Impedance planimetry-guided peroral endoscopic myotomy of the fundoplication valve

“…Previous surgical interventions had resulted in pronounced scarring and fibrosis, making further surgical interventions to release the fundoplication unfeasible. After a multidisciplinary review, we opted for a third-space endoscopic approach to dissect the fundoplication valve 1 .…”

“…Previous surgical interventions had resulted in pronounced scarring and fibrosis, making further surgical interventions to release the fundoplication unfeasible. After a multidisciplinary review, we opted for a third-space endoscopic approach to dissect the fundoplication valve [1]. Prior to and after the myotomy, intraoperative impedance planimetry with EndoFLIP was used to assess distensibility, yielding a distensibility index (DI) of 1.7 and 1.5 mm 2 /mmHg with 30-mL and 40-mL balloons, respectively, prior to myotomy.…”