Technique of preservation of vagus nerves at the lower esophagus and cardia during minimally invasive surgery for functional esophageal diseases.

Background: To show in a video the technical passages for the preservation of vagus nerves during benign esophageal surgery. Methods: 76 consecutive minimally invasive procedures were reviewed. Results: The position of the vagus nerves from the cardiac level where the left vagus becomes anterior to the lesser curvature at the level of the branch of the nerves for the gallbladder is not variable; 2) the left vagus becomes anterior and adherent to the esophagus between 6 and 9 cm above the apex of the hiatus; 3) vaguses can be visualized; their position is also assessed while passing over the cord with an endodissect device; 4) the safest way to manage the vaguses is to know exactly where they are during each step of the surgery; 5) the dangerous steps of the minimally invasive surgery are: a) the isolation of the left nerve where it becomes anterior, b) at the lesser curvature especially when resecting the fat pad or the sac of a II-IV hiatus hernia, c) when dissecting posteriorly the esophagus, in case of panmural esophagitis. The following cases are presented:1 case of normal ge-junction during GERD surgery, 2 cases of short esophagus, 2 cases of type III-IV hiatus hernias, 2 Heller-Dor operation for achalasia. 2 cases of redo surgery for recurrent hiatus hernia. Discussion: The video demonstrates several examples of booby traps for the vagus nerves integrity. When it is essential to mobilize adequately the lower esophagus, the surgeon must know in every moment where the vagus nerves are, particularly in diffi cult situations. Disclosure: All authors have declared no confl icts of interest.