A. Alves et al., Laparoscopic Heller's cardiomyotomy in achalasia - Is intraoperative endoscopy useful, and a why?, SURG ENDOSC, 13(6), 1999, pp. 600-603
Citations number
20
Categorie Soggetti
Surgery
Journal title
SURGICAL ENDOSCOPY-ULTRASOUND AND INTERVENTIONAL TECHNIQUES
Background: Inappropriate length of the myotomy incision along the stomach,
the most common technical fault during Heller's cardiomyotomy, is related
to the difficulty of identifying the gastro-esophageal junction, in particu
lar during laparoscopic surgery. The goal of this study was to evaluate the
contribution of endoscopy to gastro-esophageal junction identification dur
ing laparoscopic Heller's cardiomyotomy.
Methods: In a group of 19 patients with intraoperative endoscopy with lapar
oscopic Heller's cardiomyotomy, surgical and endoscopic criteria for gastro
-esophageal junction identification have been assessed. Then postoperative
results of this group were compared with those of another group of 16 patie
nts previously operated on without intraoperative endoscopy,
Results: Endoscopic and laparoscopic criteria for gastro-esophageal junctio
n identification were discordant in 11 patients (11/19, 58%). The cardia wa
s in all these cases at a more distal site with endoscopic criteria. Compli
cations ascribable to suboptimal technique were more frequent in the group
without intraoperative endoscopy (7/16 patients) than in the other group (2
/19 patients).
Conclusions: Endoscopy during laparoscopic Heller's cardiomyotomy is of gre
at assistance in identifying the cardia, and thereby could improve surgical
outcomes.