Oesophagocardioplasty for residual dysphagia following multiple pneumatic dilatations for achalasia

Caporale, A; Cosenza, Umile Michele; Galati, Gaspare; Fiori, Enrico; E, Benvenuto; Giuliani, Antonio

doi:10.1002/bjs.4555

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…However, oesophagectomy is associated with high morbidity and mortality rates (32.4% and 5.4%, respectively) [ 2 ]. Oesophagectomy is usually advocated in patients with a massively dilated oesophagus measuring more than 6 cm and/or with marked fibrosis, where dysphagia is unlikely to be resolved by dilatation or standard myotomy [ 2 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic hand-sewn cardioplasty: an alternative procedure for end-stage achalasia

Senra

Navaratne

Acosta-Mérida

et al. 2021

Langenbecks Arch Surg

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Background Primary achalasia is a rare oesophageal motor disorder characterized by the absence of swallow-induced relaxation of the lower oesophageal sphincter and diminished or absent oesophageal body peristalsis. Around 5% of these patients will develop end-stage achalasia, where oesophagectomy may be advocated. We present the laparoscopic hand-sewn cardioplasty as an alternative ‘oesophagus-preserving’ procedure in patients with end-stage achalasia. Methods We present a retrospective review of four patients who underwent laparoscopic hand-sewn cardioplasty. Data collected included pre-operative demographic information and investigations; and post-operative outcomes. Patients were scored pre- and post-operatively using Reflux Symptom Index, Eating Assessment Tool-10 and Voice Handicap Index-10 questionnaires. Results Four patients underwent laparoscopic hand-sewn cardioplasty during the study period. In one patient, it was performed as a rescue procedure during attempted myotomy following multiple perforations of friable mucosa. In the other three patients, laparoscopic hand-sewn cardioplasty was performed for end-stage achalasia. None of the patients had post-operative complications and all patients were discharged on the second post-operative day. All patients experienced improvement in swallowing symptoms (EAT-10; p = 0.03) but developed post-operative gastroesophageal reflux. Conclusion To our knowledge, this is the first published case series of laparoscopic hand-sewn cardioplasty for end-stage achalasia. It appears to be a safe and effective procedure for the treatment of end-stage achalasia, offering an alternative minimally invasive procedure to oesophagectomy. Laparoscopic hand-sewn cardioplasty can also be used as a ‘rescue’ procedure during myotomy in patients who have poor-quality mucosa which perforates intra-operatively or is at high risk of perforation/leaking post-operatively.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic hand-sewn cardioplasty: an alternative procedure for end-stage achalasia

Senra

Navaratne

Acosta-Mérida

et al. 2021

Langenbecks Arch Surg

View full text Add to dashboard Cite

show abstract

“…The fundic patch operation -as performed in a modified manner by Caporale et al [3] -was introduced originally by Thal and Hatafuku [11] for spontaneous rupture of the esophagus. Later, this technique was modified and its indications widened for the treatment of several benign diseases of the distal part of the esophagus [6,10].…”

Section: Commentmentioning

confidence: 99%