[Peroperative diagnostic methods during esophageal achalasia surgery. Initial experience]

Area of Science:

• Gastroenterology
• Surgical Innovation
• Diagnostic Techniques

Context:

• Achalasia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES).
• Surgical myotomy is a primary treatment for achalasia, aiming to relieve LES pressure.
• Assessing the completeness of myotomy during surgery is crucial for successful patient outcomes.

Purpose:

• To evaluate the utility of intraoperative esophageal manometry in assessing the completeness of myotomy for achalasia.
• To determine if manometry can objectively measure lower esophageal sphincter (LES) pressure changes during and after myotomy.
• To assess the impact of peroperative manometry on surgical decision-making and patient outcomes.

Summary:

• Esophageal manometry was performed twice during surgery for achalasia: pre-myotomy for LES localization and post-myotomy to verify completeness.
• Peroperative manometry demonstrated a significant decrease in LES pressure post-myotomy (mean 42.06 mmHg to 20.03 mmHg).
• In one case, manometry findings led to an extension of the myotomy, highlighting its role in surgical adjustments.

Impact:

• Peroperative esophageal manometry provides objective data to confirm the completeness of myotomy during achalasia surgery.
• This technique can identify residual high-pressure zones in the LES, potentially preventing persistent postoperative symptoms.
• Intraoperative manometry is a valuable tool that does not significantly prolong operative time while enhancing surgical precision.