Intraoperative upper GI endoscopy ensures an adequate laparoscopic Heller's myotomy

Area of Science:

• Minimally invasive surgery
• Gastrointestinal surgery
• Pediatric surgery

Background:

• Laparoscopic Heller myotomy is a surgical treatment for achalasia.
• Intraoperative upper gastrointestinal endoscopy can aid in assessing myotomy adequacy.

Purpose of the Study:

• To present a case series of laparoscopic Heller myotomies performed with intraoperative endoscopy.
• To evaluate the utility of intraoperative endoscopy in ensuring adequate myotomy and patient outcomes.

Main Methods:

• A 7-year case series of 5 patients (4 male, 1 female, average age 12.1 years) undergoing laparoscopic Heller myotomy.
• Preoperative diagnostics included upper GI contrast studies and, in some cases, manometry.
• Intraoperative endoscopy was used to assess and guide myotomy length, with pre- and postmyotomy endoscopy performed.

Main Results:

• No intraoperative mucosal perforations or conversions to open surgery occurred.
• Sixty percent of patients required myotomy extension based on intraoperative endoscopic findings.
• All patients experienced uneventful, complication-free postoperative recovery.

Conclusions:

• Intraoperative endoscopy significantly enhances the adequacy of laparoscopic Heller myotomy.
• Excellent outcomes were achieved, even in patients with prior treatments like balloon dilatation or botox injections.