STEP 4Reconstruction of the cardia

The cardia is reconstructed by suturing the tongue of the gastric fundus to the margins of the myotomy for a distance proximally of 4 cm using interrupted 3-0 Prolene sutures.

A chest tube is left in situ and brought out through a separate intercostal stab wound in the lower thorax.

The chest drain is usually removed 48h postoperatively, if the lung is completely expanded and there is no evidence of leak or infection.

The nasogastric tube is left on low suction and removed on the third postoperative day.

Patients begin liquid oral intake following nasogastric tube removal, advancing to a full fluid diet as tolerated. Analgesics and anti-emetics minimize nausea and vomiting.

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