Intraoperative Manometry during Laparoscopic Operation for Esophageal Achalasia: Does Pneumoperitoneum Affect Manometry?

Kamiike, Wataru; Taniguchi, Eiji; Iwase, Kazuhiro; Ito, Toshinori; Nezu, R; Nishida, Toshirou; Inoue, Masahiro; Ohashi, Satoshi; Matsuda, Hikaru

doi:10.1007/s002689900146

Cited by 9 publications

(4 citation statements)

References 12 publications

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“…There may be several explanations for the morphological changes to the LES during higher-pressure pneumoperitoneum in the healthy dogs of the present study. Manometric studies 20,21 of humans have revealed varying effects of increasing IAPs on LES pressures. In a small number of patients who underwent laparoscopic treatment for achalasia or cholecystectomy, pneumoperitoneum was not found to significantly affect LES pressure or LES length.…”

Section: Discussionmentioning

confidence: 99%

“…In a small number of patients who underwent laparoscopic treatment for achalasia or cholecystectomy, pneumoperitoneum was not found to significantly affect LES pressure or LES length. 20 A study 21 conducted to manometrically evaluate the effect of pneumoperitoneum on LES pressure revealed that increasing IAP was associated with a progressive increase in LES pressure. In the study reported here, IBP, which is not an indication of manometric esophageal wall pressure, steadily increased with increases in IAP, which suggested that a decrease in LES pressure alone was unlikely to be the cause of the increases in CSA and MD.…”

Section: Discussionmentioning

confidence: 99%

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Effect of changes in intra-abdominal pressure on diameter, cross-sectional area, and distensibility of the lower esophageal sphincter of healthy dogs as determined by use of an endoscopic functional luminal imaging probe

Mayhew¹,

Pitt²,

Steffey³

et al. 2016

ajvr

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OBJECTIVE To evaluate the effect of intra-abdominal pressure (IAP) on morphology and compliance of the lower esophageal sphincter (LES) by use of impedance planimetry in healthy dogs and to quantify the effect of changes in IAP. ANIMALS 7 healthy, purpose-bred sexually intact male hound-cross dogs. PROCEDURES Dogs were anesthetized, and cross-sectional area (CSA), minimal diameter (MD), LES length, LES volume, and distensibility index (DI) of the LES were evaluated by use of an endoscopic functional luminal imaging probe. For each dog, measurements were obtained before (baseline) and after creation of a pneumoperitoneum at an IAP of 4, 8, and 15 mm Hg. Order of the IAPs was determined by use of a randomization software program. RESULTS CSA and MD at 4 and 8 mm Hg were not significantly different from baseline measurements; however, CSA and MD at 15 mm Hg were both significantly greater than baseline measurements. The LES length and LES volume did not differ significantly from baseline measurements at any IAP. The DI differed inconsistently from the baseline measurement but was not substantially affected by IAP. CONCLUSIONS AND CLINICAL RELEVANCE Pneumoperitoneum created with an IAP of 4 or 8 mm Hg did not significantly alter LES morphology in healthy dogs. Pneumoperitoneum at an IAP of 15 mm Hg caused a significant increase in CSA and MD of the LES. Compliance of the LES as measured by the DI was not greatly altered by pneumoperitoneum at an IAP of up to 15 mm Hg.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of changes in intra-abdominal pressure on diameter, cross-sectional area, and distensibility of the lower esophageal sphincter of healthy dogs as determined by use of an endoscopic functional luminal imaging probe

Mayhew¹,

Pitt²,

Steffey³

et al. 2016

ajvr

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“…Concerns about verifying the extent of myotomy continue to be a source of concern 25 –27 . There are three approaches to estimating when the myotomy has been completed.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic myotomy in achalasia: intraoperative evidence for myotomy of the gastric cardia *

Donahue

Teresi

Patel

et al. 1999

Diseases of the Esophagus

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The myotomy performed for achalasia of the esophagus should divide all of the constricting, diseased muscular elements that obstruct the esophagogastric junction (EGJ). Whether the disease process includes proximal gastric as well as esophageal components is as yet unclear, but anatomic evidence complemented by clinical data suggest that the disease process does not end at the evanescent and poorly defined EGJ. Clinical reports from enthusiastic proponents of a particular operative approach for achalasia have not been illuminating in this regard, because all patients are improved to some degree post-operatively, and there are no objective parametric standards for the evaluation of swallowing function. This study reports a series of patients in whom endoscopic viewing was used to judge the adequacy of myotomy after 'esophageal' myotomy. The question posed by this study was, 'Does esophageal myotomy remove all constricting elements at the gastroesophageal junction?' Laparoscopic myotomy was performed in 48 patients with a diagnosis of achalasia; these patients are the most recent in a total cohort of 72 patients operated upon for achalasia during the past 20 years. Myotomy was begun on the esophagus, and extended to the esophagogastric junction; anatomic landmarks, including the appearance of submucosal veins, guided the initial dissection. Intraoperative endoscopy was then performed to determine whether there was residual constriction of the channel between the esophagus and stomach; if so, myotomy was extended onto the gastric cardia until visual evidence of obstruction had disappeared. All patients had either Toupet fundoplication or Dor fundoplication after myotomy. There were obvious constricting elements distal to the gastroesophageal junction in 90% of the patients. These patients required extension of the myotomy onto the stomach for an average of 15 mm. All but one patient had improved swallowing post-operatively. Eight patients required 'stretch' of the distal esophagus/cardia within the first year post-operatively; one patient was reoperated for fibrous scar obstruction of the distal esophagus. Esophageal myotomy limited to the esophageal muscle does not remove all constricting elements at the gastroesophageal junction; as a result, the extended myotomy must be complemented by an antireflux procedure during operations for achalasia.

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“…However, it is often technically difficult to achieve these goals in laparoscopic approach where tactile feedback is virtually absent. The usefulness of intraoperative manometry therefore has been described as an adjunct technique [5,6,7]. …”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Heller-Dor Surgery for Esophageal Achalasia: Impact of Intraoperative Real-Time Manometric Feedback on Postoperative Outcomes

Endo

Nakajima²,

Nishikawa³

et al. 2009

Dig Surg

Self Cite

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Background: Laparoscopic Heller myotomy with Dor fundoplication (LHD) is one of the most established surgical procedures for esophageal achalasia. Preoperative esophageal manometry has been reported as useful to evaluate lower esophageal sphincter (LES) pressure. However, the feasibility, safety, and impact of its intraoperative use have not been fully evaluated, especially when enhanced with real-time 3-D pressure imaging. Methods: LHD was attempted on 24 consecutive patients with esophageal achalasia. Manometry was performed at 3 time points during LHD: before myotomy, after myotomy, and after fundoplication. Investigations included esophagography, manometry, and 24-hour esophageal pH monitoring in the preoperative, short-term (0–5 months) and long-term (1–3 years) follow-up periods. Results: The 3-D intraoperative manometric images were presented to the surgical crew on a monitor screen immediately after each measurement in all attempted cases (n = 13). Any residual high pressure zone of the LES was easily recognized and resolved with additional myotomy. Postoperative esophagographies showed resolution of esophageal dilatation. Manometric examination revealed significant reduction of LES pressure in the short-/long-term follow-up periods. PH monitoring showed no increase in acid reflux. Overall outcomes were satisfactory (symptom relief = 95%). Conclusion: Intraoperative manometry with real-time pressure feedback is a feasible, safe, and useful adjunct in LHD.

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Intraoperative Manometry during Laparoscopic Operation for Esophageal Achalasia: Does Pneumoperitoneum Affect Manometry?

Cited by 9 publications

References 12 publications

Effect of changes in intra-abdominal pressure on diameter, cross-sectional area, and distensibility of the lower esophageal sphincter of healthy dogs as determined by use of an endoscopic functional luminal imaging probe

Effect of changes in intra-abdominal pressure on diameter, cross-sectional area, and distensibility of the lower esophageal sphincter of healthy dogs as determined by use of an endoscopic functional luminal imaging probe

Laparoscopic myotomy in achalasia: intraoperative evidence for myotomy of the gastric cardia *

Laparoscopic Heller-Dor Surgery for Esophageal Achalasia: Impact of Intraoperative Real-Time Manometric Feedback on Postoperative Outcomes

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