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Laparoscopic Heller's cardiomyotomy in achalasia. Is intraoperative endoscopy useful, and why?
A Alves1, T Perniceni, P Godeberge
1Medicosurgical Digestive Disease Unit, Montsouris Institute, Paris 6 University, 6 place de Port au Prince, 75013 Paris, France.
Insights
Intraoperative endoscopy aids in identifying the gastro-esophageal junction during laparoscopic Heller
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Inappropriate myotomy incision length is a common technical fault in Heller's cardiomyotomy.
- Difficulty identifying the gastro-esophageal junction, especially laparoscopically, contributes to this fault.
Purpose of the Study:
- To assess the utility of endoscopy in identifying the gastro-esophageal junction during laparoscopic Heller's cardiomyotomy.
Main Methods:
- Compared surgical and endoscopic criteria for gastro-esophageal junction identification in 19 patients undergoing intraoperative endoscopy.
- Compared postoperative outcomes of this group with 16 patients operated on without intraoperative endoscopy.
Main Results:
- Endoscopic and laparoscopic criteria for gastro-esophageal junction identification differed in 58% of patients (11/19).
- Cardia was consistently located more distally by endoscopic criteria.
- Fewer complications occurred in the endoscopy group (2/19) compared to the non-endoscopy group (7/16).
Conclusions:
- Intraoperative endoscopy significantly assists in accurate cardia identification during laparoscopic Heller's cardiomyotomy.
- This improved identification has the potential to enhance surgical outcomes and reduce complications.
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 particular during laparoscopic surgery. The goal of this study was to evaluate the contribution of endoscopy to gastro-esophageal junction identification during laparoscopic Heller's cardiomyotomy.
Methods:
In a group of 19 patients with intraoperative endoscopy with laparoscopic 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 patients previously operated on without intraoperative endoscopy.
Results:
Endoscopic and laparoscopic criteria for gastro-esophageal junction identification were discordant in 11 patients (11/19, 58%). The cardia was in all these cases at a more distal site with endoscopic criteria. Complications 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 great assistance in identifying the cardia, and thereby could improve surgical outcomes.