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Published on: February 16, 2024
Mucosal Perforation During Laparoscopic Heller Myotomy Has No Influence on Final Treatment Outcome
Renato Salvador1, Lorenzo Spadotto1, Giovanni Capovilla1
1Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Background:
The aims of the study were (a) to examine the final outcome in patients experiencing accidental mucosal perforation during laparoscopic Heller myotomy with Dor fundoplication (LHD) and (b) to evaluate whether perforation episodes might influence the way in which surgeons subsequently approached the LHD procedure.
Methods:
We studied all consecutive patients that underwent LHD between 1992 and 2015. Patients were divided into two main groups: those who experienced an intraoperative mucosal perforation (group P) and those whose LHD was uneventful (group NP). Two additional groups were compared: group A, which consisted of patients operated by a given surgeon immediately before a perforation episode occurred, and group B, which included those operated immediately afterwards.
Results:
Eight hundred seventy-five patients underwent LHD; a mucosal perforation was detected in 25 patients (2.9 %), which was found unrelated to patients' symptom's score and age, radiological stage, manometric pattern, or the surgeon's experience. The median postoperative symptom score was similar for the two groups as the failure rate: 92 failures in group NP (10.8 %) and 4 in group P (16 %) (p = 0.34); moreover, symptoms recurred in 2 patients of group A (10 %) and 3 patients of group B (15 %) (p = 0.9).
Conclusions:
Accidental perforation during LHD is infrequent and impossible to predict on the grounds of preoperative therapy or the surgeon's personal experience. Despite a longer surgical procedure and hospital stay, the outcome of LHD is much the same as for patients undergoing uneventful myotomy. A recent mucosal perforation does not influence the surgeon's subsequent performance.
Insights
Accidental mucosal perforation during laparoscopic Heller myotomy with Dor fundoplication (LHD) is rare and does not impact patient outcomes. Perforations do not alter surgeons' subsequent LHD approach.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Safety
Background:
- Laparoscopic Heller myotomy with Dor fundoplication (LHD) is a standard procedure for achalasia.
- Intraoperative mucosal perforation is a potential complication during LHD.
- Understanding the impact of perforations on outcomes and surgical practice is crucial.
Purpose of the Study:
- To assess the final outcomes in patients experiencing accidental mucosal perforation during LHD.
- To determine if perforation events influence subsequent surgical approaches to LHD.
Main Methods:
- Retrospective analysis of 875 consecutive LHD patients (1992-2015).
- Patients divided into groups based on intraoperative mucosal perforation (group P) versus uneventful procedures (group NP).
- Comparison of outcomes between patients operated immediately before (group A) and after (group B) a perforation event.
Main Results:
- A mucosal perforation occurred in 2.9% of patients (25/875), unrelated to preoperative factors or surgeon experience.
- Postoperative symptom scores and failure rates were similar between perforated (16%) and non-perforated (10.8%) groups (p=0.34).
- Symptom recurrence rates were comparable in surgeons before (10%) and after (15%) a perforation (p=0.9).
Conclusions:
- Accidental LHD perforation is infrequent, unpredictable, and does not affect long-term patient outcomes.
- Despite longer procedures and hospital stays, outcomes remain comparable to uneventful LHD.
- Perforation events do not alter surgeons' subsequent procedural performance or approach.
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