视频1在术前食道，一个典型的鸟的喙图像显示在胃食管交界处。胃-胃瘘,从贲门到眼底，也显示了。介绍了一种装有远端透明帽的镜。在贲门，我们看到瘘管的近端开口。这里,我们看到胃底。当我们下去的时候，胃袋是规则的，再往下我们就到幽门了.在回射视图中，我们认识到新幽门和瘘管的远端开口。在食管前壁粘膜下注射后，做一个纵向粘膜切口。使用内窥镜粘膜下剥离技术进行粘膜下隧道。到达胃食管交界处，典型纺锤体静脉的发现证实了这一点。这里,我们显示了穿过贲门的粘膜下隧道，延伸到胃袋2厘米。没有遇到过去手术的障碍。通过可视化蓝色垫子也可以确认隧道向下延伸到card门的正确延伸。进行（肌层）圆形层的解剖并将其带入the中。粘膜下隧道是光滑的，没有与过去的手术有关的问题。这里,我们证明了肌切开术被穿过贲门进入胃袋。我们可以看到更复杂的肌纤维组织。再一次,没有遇到过去手术的障碍。然后沿着粘膜下通道的整个长度完成肌切开术。最终进行粘膜切口的夹子闭合。
Video 1At preoperative esophagram, a typical bird\'s beak image is shown at the gastroesophageal junction. A gastro-gastric fistula, opening from cardia to fundus, is also shown. A scope fitted with a distal clear cap is introduced. At the cardia, we see the proximal opening of the fistula. Here, we see the gastric fundus. As we go down, the gastric pouch is regular, and further down we reach the pylorus. In the retroflexed view, we recognize the neo-pylorus and the distal opening of the fistula. After submucosal injection on the anterior wall of the esophagus, a longitudinal mucosal incision is made. Submucosal tunnelling is performed using the endoscopic submucosal dissection technique. The gastroesophageal junction is reached, as confirmed by the finding of typical spindle veins. Here, we show submucosal tunnelling across the cardia, extending 2 cm into the gastric pouch. No obstacles from past surgery are encountered. Correct extension of the tunnel down into the cardia is also confirmed by visualizing a blue cushion. Dissection of a circular layer (of the muscularis) is performed and carried into the cardia. Submucosal tunnel is smoothy performed with no issues related to past surgery. Here, we demonstrate myotomy being carried into the gastric pouch across the cardia. We can see the more complex organization of muscular fibers. Again, no obstacles from past surgery are encountered. Myotomy is then completed along the entire length of the submucosal tunnel. Clip closure of the mucosal incision is eventually performed.
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