Laparoscopic Heller's cardiomyotomy in achalasia - Is intraoperative endoscopy useful, and a why?

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.