BACKGROUND: Perforation of the esophagus after pneumatic dilation for achalasia is a severe complication which should be treated accurately in order to obtain a successful immediate outcome and a satisfactory result for the underlying condition. METHODS: Five consecutive patients presenting with distal esophageal perforation after pneumatic dilation for achalasia were included in this study. All patients had gastrografin swallow performed to confirm the perforation, and one patient was also submitted to flexible esophagoscopy. Laparoscopic approach was performed in all patients with five portals. The phrenoesophageal membrane was opened on its anterior aspect. The distal esophagus was dissected free, and perforations were identified with the help of methylene blue or milk administration through the esophageal tube. All perforations were sutured with interrupted absorbable sutures. Contralateral myotomy and partial anterior Dor fundoplication completed the operation. Endoscopic control of length of myotomy and watertightness of mucosal closure was performed in all cases. RESULTS: There were no intraoperative complications. After surgery all patients were maintained with nil per os until a barium swallow showed no leakage. One patient had a radiologic leakage sustained for 1 week. All patients were dismissed uneventfully. At 6 months after surgery, esophageal manometry was performed. Mean lower esophageal sphincter resting pressure had fallen from 30 to 8.7 mmHg. CONCLUSIONS: Laparoscopy offers an excellent approach to treat distal esophageal instrumental perforations, perhaps even better than open surgery. Suture of the perforation, contralateral myotomy and partial anterior fundoplication is a good option in the treatment of perforated achalasia after pneumatic dilation.
BACKGROUND: Perforation of the esophagus after pneumatic dilation for achalasia is a severe complication which should be treated accurately in order to obtain a successful immediate outcome and a satisfactory result for the underlying condition. METHODS: Five consecutive patients presenting with distal esophageal perforation after pneumatic dilation for achalasia were included in this study. All patients had gastrografin swallow performed to confirm the perforation, and one patient was also submitted to flexible esophagoscopy. Laparoscopic approach was performed in all patients with five portals. The phrenoesophageal membrane was opened on its anterior aspect. The distal esophagus was dissected free, and perforations were identified with the help of methylene blue or milk administration through the esophageal tube. All perforations were sutured with interrupted absorbable sutures. Contralateral myotomy and partial anterior Dor fundoplication completed the operation. Endoscopic control of length of myotomy and watertightness of mucosal closure was performed in all cases. RESULTS: There were no intraoperative complications. After surgery all patients were maintained with nil per os until a barium swallow showed no leakage. One patient had a radiologic leakage sustained for 1 week. All patients were dismissed uneventfully. At 6 months after surgery, esophageal manometry was performed. Mean lower esophageal sphincter resting pressure had fallen from 30 to 8.7 mmHg. CONCLUSIONS: Laparoscopy offers an excellent approach to treat distal esophageal instrumental perforations, perhaps even better than open surgery. Suture of the perforation, contralateral myotomy and partial anterior fundoplication is a good option in the treatment of perforated achalasia after pneumatic dilation.
Authors: M Costantini; G Zaninotto; E Guirroli; C Rizzetto; G Portale; A Ruol; L Nicoletti; E Ancona Journal: Surg Endosc Date: 2005-01-10 Impact factor: 4.584
Authors: Giovanni Zaninotto; Vito Annese; Mario Costantini; Alberto Del Genio; Michela Costantino; Magdalena Epifani; Giovanni Gatto; Vittorio D'onofrio; Luigi Benini; Sandro Contini; Daniela Molena; Giorgio Battaglia; Berardino Tardio; Angelo Andriulli; Ermanno Ancona Journal: Ann Surg Date: 2004-03 Impact factor: 12.969
Authors: Constantine T Frantzides; Ronald E Moore; Mark A Carlson; Atul K Madan; John G Zografakis; Ali Keshavarzian; Claire Smith Journal: J Gastrointest Surg Date: 2004-01 Impact factor: 3.452
Authors: Peter D Siersema; Marjolein Y V Homs; Jelle Haringsma; Huug W Tilanus; Ernst J Kuipers Journal: Gastrointest Endosc Date: 2003-09 Impact factor: 9.427
Authors: Daniel von Renteln; Melina C Vassiliou; Karel Caca; Arthur Schmidt; Richard I Rothstein Journal: Surg Endosc Date: 2010-12-07 Impact factor: 4.584
Authors: Rosa M Jimenez Rodriguez; Juan José Segura-Sampedro; Mercedes Flores-Cortés; Francisco López-Bernal; Cristobalina Martín; Verónica Pino Diaz; Felipe Pareja Ciuro; Javier Padillo Ruiz Journal: World J Gastroenterol Date: 2016-03-07 Impact factor: 5.742
Authors: Salvatore Tolone; Paolo Limongelli; Gianmattia Del Genio; Luigi Brusciano; Antonio Russo; Lorenzo Cipriano; Marco Terribile; Giovanni Docimo; Roberto Ruggiero; Ludovico Docimo Journal: World J Gastrointest Endosc Date: 2014-09-16
Authors: László Andrási; Attila Paszt; Zsolt Simonka; Szabolcs Ábrahám; Márton Erdős; András Rosztóczy; Georgina Ollé; György Lázár Journal: JSLS Date: 2021 Jan-Mar Impact factor: 2.172