LOCAL EPINEPHRINE FACILITATES LAPAROSCOPIC HELLER MYOTOMY

Incomplete myotomy and mucosal perforation are the most common technic al complications of laparoscopic esophageal myotomy, The muscle layers of the lower esophagus are infiltrated with a 1:100,000 epinephrine s olution using a thin needle. Gentle pressure is applied with a peanut sponge to diminish the edema produced by the injections. The longitudi nal fibers are separated with a dissector and the semicircular fibers are lifted from the submucosa with a dissector or a hook, The muscle t ransection is done simply by tearing the fibers or cutting them with s cissors, No coagulation is required, Infiltration and topical applicat ion of epinephrine solution allowed the performance of 22 laparoscopic esophageal myotomies with excellent visualization, complete muscle di vision, and without any esophageal or gastric perforation. Injection a nd topical application of epinephrine solution to the area of the esop hagus and stomach which will be subjected to myotomy greatly facilitat es the procedure and helps to avoid complications.