# Heineke-Mikulicz Stricturoplasty Code



## choule (Oct 24, 2016)

I am newer to general surgery and could use some help with this one please. 

An incision was made through her previous neck incision and carried down. The sternocleidomastoid on the right was divided. Dissection was carried out to identify the esophagus and dissect it free from the trachea. The recurrent laryngeal nerve was not definitely identified in this scar tissue. Dissecting medially, suddenly a small amount of purulent material was encountered which may have correlated with a persistence of her medial diverticulum from seeing occasionally on 
previous esophagograms and endoscopy procedures. A Fogarty balloon was inserted through the mouth and into the transposed stomach. The balloon was inflated and there appeared to be some degree of stricturing of the esophagogastric anastomosis. Once there was adequate length, stay sutures were placed on the stomach medial and laterally to help with traction. A longitudinal incision was made into the esophagus and carried down into the stomach and this was converted to a transverse repair. Once the Heineke-Mikulicz stricturoplasty was completed the endoscope was inserted again to visualize the area. There was easy passage of the scope through the area of the stricturoplasty. However, with insufflation of air there was some leaking from the posterior aspect of the esophagus in the area where the purulent drainage had been encountered. This was controlled with a series of 3-0 PDS sutures. Of note, the stricturoplasty was completed with 3-0 PDS sutures. After all the stricturoplasty was completed a 1/4 inch Penrose drain was placed through the lateral aspect of the neck incision and behind the esophagus just above the stricturoplasty and in the area where the purulent material had been encountered. The clavicle was brought together with 2-0 PDS suture and then wrapped with a fine Vicryl mesh gauze to envelop the two ends of the clavicle with the hope of stabilizing this fracture. The wound was irrigated well and then closed in layers with absorbable suture. The sternocleidomastoid was reapproximated with interrupted Vicryl sutures. 

Thanks!


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