Operative manometry and endoscopy during laparoscopic Heller myotomy

Tatum, Roger P.; Kahrilas, Peter J.; Manka, Michael; Joehl, Raymond J.

doi:10.1007/s004649901159

Cited by 20 publications

(13 citation statements)

References 14 publications

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“…These rates were apparently higher than those seen in previous reports: 6.7–17% of postoperative patients [14,15,16]. Tatum et al [7] mentioned that patients with achalasia might be less sensitive to significant gastroesophageal reflux than the general population. Donahue et al concluded that pH studies were not helpful to understand reflux in achalasia patients, since a pH probe might record a single reflux episode lasting for hours in a patient with an aperistaltic esophagus, resulting in a false-positive result [17].…”

Section: Discussioncontrasting

confidence: 54%

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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

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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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Section: Discussioncontrasting

confidence: 54%

“…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

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“…One should mention the importance and utility of pre-, intra-, and postoperative esophagogastric manometry in the treatment of achalasia (31). Preoperative manometry enables the objective evaluation of disease progression and guides the surgeon's choice in optimal fundoplication procedure.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Esophageal Achalasia - Pneumatic Dilatation Vs Surgical Procedure

Kawiorski¹,

Popiela

Kibil

et al. 2007

Polish Journal of Surgery

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Esophageal achalasia, one of the most common motor activity disturbances of the upper gastrointestinal tract, continues to pose a significant diagnostic and therapeutic problem, especially in patients with milder forms of the disease. The aim of the study was to evaluate and compare treatment results (pneumatic dilatation, cardiomyotomy) in patients with esophageal achalasia, as well as determine the usefulness of intraoperative, continuous manometric monitoring of the corrected segment of the "esophagogastric junction" (evaluation of myotomy). Material and methods. The study group comprised 104 patients, including 71 female and 33 male, treated at the Department during the period between 1997 and 2004. The mean patient age was 43.5 years, ranging between 19 and 75 years. The duration of the disease ranged between 5 months and 22 years. Every patient was subjected to endoscopy, histopathological, radiological and manometric examinations, before treatment. The therapeutic model was based on a two-staged management process. During the initial stage of therapy, patients were subjected to 2-3 pneumatic dilatations. A lack of response to treatment was considered treatment failure and these patients qualified for surgery -Heller's myotomy with antireflux treatment (fundoplication). Cachectic patients requiring immediate surgical intervention were excluded from the study. Results. Following pneumatic dilatation, good or very good results were obtained in 73 (70.2%) of the 104 patients. Procedures were repeated in only 8 (11%) patients, due to the recurrence of dysphagia. The remaining 31 (29.8%) patients underwent surgery with simultaneous intraoperative manometric control of the performed myotomy. Conclusions. Based on the obtained results, one can confirm the significant efficacy of pneumatic dilatation, which is considered the ultimate therapy. In the case of patients in whom we were not able to obtain good clinical results, one observed improved esophagogastric passage, which in turn improved nutritional parameters before planned surgical intervention. Intraoperative esophageal manometry enabled us to accurately evaluate the correctness of myotomy, which seemed to be an indispensable element in the prevention of disease recurrence.

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“…Most perforations are recognized at the time of surgery and repaired successfully without sequelae. 1,[7][8][9][10][11][12][13][14][15][16][17][18][19] Laparoscopic Esophagomyotomy…”

Section: Esophagomyotomymentioning

confidence: 99%

“…Development of highly effective minimally invasive approaches for esophagomyotomy has more recently resulted in increasing popularity for primary operative treatment of achalasia. 1,[7][8][9][10][11][12][13][14][15][16][17][18][19] Patients are counseled about various methods of treatment, success and failure rates for operation, peri-operative expectations, and operative risks, especially the risk of conversion to open operation and esophageal perforation. It is also important for patients to understand that the operation, if successful, will markedly improve swallowing but will not restore normal swallowing since peristalsis remains abnormal.…”

Section: Esophagomyotomymentioning

confidence: 99%

Laparoscopic Esophagomyotomy for Achalasia: How I Do It

Rivas

Rege

2009

Journal of Gastrointestinal Surgery

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Laparoscopic myotomy is performed routinely at our institution in the lithotomy position under endoscopic control. The techniques for performing the myotomy, the use of fundoplication, and the adaptation of this approach to use the surgical robot are described. Laparoscopic esophagomyotomy has been highly effective, durable, safe, and widely accepted by patients. There is less data about the robotic approach, but increased degrees of freedom afforded by articulation in the instruments promises finer control and possibly lower perforation rates.

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Operative manometry and endoscopy during laparoscopic Heller myotomy

Abstract: Our initial experience suggests that operative esophageal manometry is a useful adjunct to upper endoscopy during laparoscopic Heller myotomy, quantitatively assuring obliteration of the nonrelaxing LES and HPZ.

Cited by 20 publications

References 14 publications

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

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

Treatment of Esophageal Achalasia - Pneumatic Dilatation Vs Surgical Procedure

Laparoscopic Esophagomyotomy for Achalasia: How I Do It

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