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Mucosal injury during laparoscopic Heller cardiomyotomy: risk factors and impact on surgical outcomes
El-Sayed Abou El-Magd1, Ahmed Elgeidie2, Amr Abbas2
1Department of General Surgery, Faculty of Medicine, Gastrointestinal Surgical Center GISC, Mansoura University, Gehan Street, Al Dakahlia Governorate, Mansoura, 35511, Egypt. gec_drelsayedadel86@hotmail.com.
Purpose:
To investigate the risk factors and outcomes of mucosal perforation (MP) during laparoscopic Heller myotomy (LHM) in patients with achalasia.
Methods:
We conducted a retrospective analysis of patients who underwent LHM for achalasia at a single facility.
Results:
Among 412 patients who underwent LHM for achalasia, MP was identified in 52 (12.6%). Old age, long disease duration, low albumin level, an esophageal transverse diameter > 6 cm, and a sigmoid-shaped esophagus were found to be independent predictors of MP. These factors were assigned a pre-operative score to predict the perforation risk. MP had a significant impact on intra and post-operative outcomes. Gastric side perforation was associated with a higher incidence of reflux symptoms, whereas esophageal-side perforation had a higher incidence of residual dysphagia.
Conclusions:
Many risk factors for MP have been identified. Correctable parameters like low serum albumin should be resolved prior to surgery, while uncorrectable parameters like old age and a sigmoid-shaped esophagus should be managed by experienced surgeons in high-volume centers. Implementing these recommendations will help decrease the incidence and consequences of this serious complication.
Insights
Mucosal perforation (MP) during laparoscopic Heller myotomy (LHM) for achalasia is predicted by age, disease duration, low albumin, and esophageal shape. Experienced surgeons and pre-operative correction of factors like albumin can reduce MP incidence and improve outcomes.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Disorders
Background:
- Achalasia is a primary esophageal motility disorder.
- Laparoscopic Heller myotomy (LHM) is a standard surgical treatment for achalasia.
- Mucosal perforation (MP) is a potential complication during LHM.
Purpose of the Study:
- To identify risk factors for mucosal perforation (MP) during laparoscopic Heller myotomy (LHM) in achalasia patients.
- To evaluate the impact of MP on intra- and post-operative outcomes.
- To develop a predictive scoring system for MP risk.
Main Methods:
- Retrospective analysis of 412 patients undergoing LHM for achalasia.
- Identification of independent predictors for MP.
- Development of a pre-operative scoring system based on identified risk factors.
Main Results:
- Mucosal perforation (MP) occurred in 12.6% of patients.
- Independent predictors of MP included old age, long disease duration, low albumin, esophageal diameter >6 cm, and sigmoid esophagus.
- MP significantly impacted intra- and post-operative outcomes, with different consequences based on perforation location (gastric vs. esophageal).
Conclusions:
- Several pre-operative factors predict MP risk during LHM for achalasia.
- Correctable factors (e.g., low albumin) should be addressed before surgery.
- Uncorrectable factors (e.g., age, esophageal shape) necessitate management by experienced surgeons in high-volume centers to minimize MP incidence and consequences.
