Yoshihito Souma1, Kiyokazu Nakajima2,3, Eiji Taniguchi4, Tsuyoshi Takahashi5, Yukinori Kurokawa5, Makoto Yamasaki5, Yasuhiro Miyazaki5, Tomoki Makino5, Tetsuhiro Hamada1, Jun Yasuda1, Takeyoshi Yumiba1, Shuichi Ohashi1, Shuji Takiguchi5, Masaki Mori5, Yuichiro Doki5. 1. Department of Surgery, Osaka Central Hospital, 3-3-30, Umeda, Kita-ku, Osaka, 530-0001, Japan. 2. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. knakajima@gesurg.med.osaka-u.ac.jp. 3. Division of Next Generation Endoscopic Intervention, Global Center for Medical Engineering and Informatics, Osaka University, 2-2, E-2, Yamadaoka, Suita, Osaka, 565-0871, Japan. knakajima@gesurg.med.osaka-u.ac.jp. 4. Department of surgery, Otemae Hospital, Osaka, Japan. 5. Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Abstract
BACKGROUND: Controversy remains whether preoperative pneumatic balloon dilation (PBD) influences the surgical outcome of laparoscopic esophagocardiomyotomy in patients with esophageal achalasia. The aim of this study was to evaluate whether preoperative PBD represents a risk factor for surgical complications and affects the symptomatic and/or functional outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD). METHODS: A retrospective chart review was conducted on a prospectively compiled surgical database of 103 consecutive patients with esophageal achalasia who underwent LHD from November 1994 to September 2014. The following data were compared between the patients with preoperative PBD (PBD group; n = 26) and without PBD (non-PBD group; n = 77): (1) patients' demographics: age, gender, body mass index, duration of symptoms, maximum transverse diameter of esophagus; (2) operative findings: operating time, blood loss, intraoperative complications; (3) postoperative course: complications, clinical symptoms, postoperative treatment; and (4) esophageal functional tests: preoperative and postoperative manometric data and postoperative profile of 24-h esophageal pH monitoring. RESULTS: (1) No significant differences were observed in the patients' demographics. (2) Operative findings were similar between the two groups; however, the incidence of mucosal perforation was significantly higher in the PBD group (n = 8; 30.7 %) compared to the non-PBD group (n = 6; 7.7 %) (p = 0.005). (3) Postoperative complications were not encountered in either group. The differences were not significant for postoperative clinical symptoms, the incidence of gastroesophageal reflux disease, or necessity of postoperative treatments. (4) Lower esophageal sphincter pressure was effectively reduced in both groups, and no differences were observed in manometric data or 24-h pH monitoring profiles between the two groups. Multivariate logistic regression analysis showed that preoperative PBD and the maximum transverse diameter of esophagus were significantly associated with intraoperative mucosal perforation. CONCLUSIONS: Although postoperative outcomes were not affected, additional caution is recommended in identifying intraoperative mucosal perforation in patients with preoperative PBD when performing LHD.
BACKGROUND: Controversy remains whether preoperative pneumatic balloon dilation (PBD) influences the surgical outcome of laparoscopic esophagocardiomyotomy in patients with esophageal achalasia. The aim of this study was to evaluate whether preoperative PBD represents a risk factor for surgical complications and affects the symptomatic and/or functional outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD). METHODS: A retrospective chart review was conducted on a prospectively compiled surgical database of 103 consecutive patients with esophageal achalasia who underwent LHD from November 1994 to September 2014. The following data were compared between the patients with preoperative PBD (PBD group; n = 26) and without PBD (non-PBD group; n = 77): (1) patients' demographics: age, gender, body mass index, duration of symptoms, maximum transverse diameter of esophagus; (2) operative findings: operating time, blood loss, intraoperative complications; (3) postoperative course: complications, clinical symptoms, postoperative treatment; and (4) esophageal functional tests: preoperative and postoperative manometric data and postoperative profile of 24-h esophageal pH monitoring. RESULTS: (1) No significant differences were observed in the patients' demographics. (2) Operative findings were similar between the two groups; however, the incidence of mucosal perforation was significantly higher in the PBD group (n = 8; 30.7 %) compared to the non-PBD group (n = 6; 7.7 %) (p = 0.005). (3) Postoperative complications were not encountered in either group. The differences were not significant for postoperative clinical symptoms, the incidence of gastroesophageal reflux disease, or necessity of postoperative treatments. (4) Lower esophageal sphincter pressure was effectively reduced in both groups, and no differences were observed in manometric data or 24-h pH monitoring profiles between the two groups. Multivariate logistic regression analysis showed that preoperative PBD and the maximum transverse diameter of esophagus were significantly associated with intraoperative mucosal perforation. CONCLUSIONS: Although postoperative outcomes were not affected, additional caution is recommended in identifying intraoperative mucosal perforation in patients with preoperative PBD when performing LHD.
Entities:
Keywords:
Esophageal achalasia; Functional outcome; Intraoperative mucosal perforation; Laparoscopic Heller myotomy with Dor fundoplication; Pneumatic balloon dilation; Symptomatic outcome
Authors: Subrato Deb; Claude Deschamps; Mark S Allen; Francis C Nichols; Stephen D Cassivi; Brian S Crownhart; Peter C Pairolero Journal: Ann Thorac Surg Date: 2005-10 Impact factor: 4.330
Authors: K Nakajima; M Wasa; H Kawahara; H Soh; E Taniguchi; S Ohashi; A Okada Journal: Surg Laparosc Endosc Percutan Tech Date: 2000-08 Impact factor: 1.719
Authors: Kaveh Farhoomand; Jason T Connor; Joel E Richter; Edgar Achkar; Michael F Vaezi Journal: Clin Gastroenterol Hepatol Date: 2004-05 Impact factor: 11.382
Authors: Markus B Schoenberg; Svetlana Marx; Jan F Kersten; Thomas Rösch; Sebastian Belle; Georg Kähler; Melina C Vassiliou; Stefan Lüth; Daniel von Renteln Journal: Ann Surg Date: 2013-12 Impact factor: 12.969