Laparoscopic total esophagogastric dissociation.

The total esophagogastric dissociation (Bianchi's procedure) is used to control the severe gastroesophageal reflux in patients after failure of the fundoplication techniques. The laparoscopic approach can be usefully performed in patients with impaired respiratory function. We report here 2 patients in whom the total esophagogastric dissociation has been entirely performed by laparoscopy. The laparoscopic examination of the proximal esojejunal anastomosis is made feasible using an intestinal clamp placed to avoid the esophageal retraction up into the posterior mediastinum. The principal complication after this surgery is the risk of internal hernia.