BACKGROUND: The aims of the study were (a) to examine the final outcome in patients experiencing accidental mucosal perforation during laparoscopic Heller myotomy with Dor fundoplication (LHD) and (b) to evaluate whether perforation episodes might influence the way in which surgeons subsequently approached the LHD procedure. METHODS: We studied all consecutive patients that underwent LHD between 1992 and 2015. Patients were divided into two main groups: those who experienced an intraoperative mucosal perforation (group P) and those whose LHD was uneventful (group NP). Two additional groups were compared: group A, which consisted of patients operated by a given surgeon immediately before a perforation episode occurred, and group B, which included those operated immediately afterwards. RESULTS: Eight hundred seventy-five patients underwent LHD; a mucosal perforation was detected in 25 patients (2.9 %), which was found unrelated to patients' symptom's score and age, radiological stage, manometric pattern, or the surgeon's experience. The median postoperative symptom score was similar for the two groups as the failure rate: 92 failures in group NP (10.8 %) and 4 in group P (16 %) (p = 0.34); moreover, symptoms recurred in 2 patients of group A (10 %) and 3 patients of group B (15 %) (p = 0.9). CONCLUSIONS: Accidental perforation during LHD is infrequent and impossible to predict on the grounds of preoperative therapy or the surgeon's personal experience. Despite a longer surgical procedure and hospital stay, the outcome of LHD is much the same as for patients undergoing uneventful myotomy. A recent mucosal perforation does not influence the surgeon's subsequent performance.
BACKGROUND: The aims of the study were (a) to examine the final outcome in patients experiencing accidental mucosal perforation during laparoscopic Heller myotomy with Dor fundoplication (LHD) and (b) to evaluate whether perforation episodes might influence the way in which surgeons subsequently approached the LHD procedure. METHODS: We studied all consecutive patients that underwent LHD between 1992 and 2015. Patients were divided into two main groups: those who experienced an intraoperative mucosal perforation (group P) and those whose LHD was uneventful (group NP). Two additional groups were compared: group A, which consisted of patients operated by a given surgeon immediately before a perforation episode occurred, and group B, which included those operated immediately afterwards. RESULTS: Eight hundred seventy-five patients underwent LHD; a mucosal perforation was detected in 25 patients (2.9 %), which was found unrelated to patients' symptom's score and age, radiological stage, manometric pattern, or the surgeon's experience. The median postoperative symptom score was similar for the two groups as the failure rate: 92 failures in group NP (10.8 %) and 4 in group P (16 %) (p = 0.34); moreover, symptoms recurred in 2 patients of group A (10 %) and 3 patients of group B (15 %) (p = 0.9). CONCLUSIONS: Accidental perforation during LHD is infrequent and impossible to predict on the grounds of preoperative therapy or the surgeon's personal experience. Despite a longer surgical procedure and hospital stay, the outcome of LHD is much the same as for patients undergoing uneventful myotomy. A recent mucosal perforation does not influence the surgeon's subsequent performance.
Authors: Renato Salvador; Mario Costantini; Francesco Cavallin; Lisa Zanatta; Elena Finotti; Cristina Longo; Loredana Nicoletti; Giovanni Capovilla; Romeo Bardini; Giovanni Zaninotto Journal: J Gastrointest Surg Date: 2013-09-10 Impact factor: 3.452
Authors: Guy E Boeckxstaens; Vito Annese; Stanislas Bruley des Varannes; Stanislas Chaussade; Mario Costantini; Antonello Cuttitta; J Ignasi Elizalde; Uberto Fumagalli; Marianne Gaudric; Wout O Rohof; André J Smout; Jan Tack; Aeilko H Zwinderman; Giovanni Zaninotto; Olivier R Busch Journal: N Engl J Med Date: 2011-05-12 Impact factor: 91.245
Authors: Giovanni Zaninotto; Mario Costantini; Christian Rizzetto; Lisa Zanatta; Emanuela Guirroli; Giuseppe Portale; Loredana Nicoletti; Francesco Cavallin; Giorgio Battaglia; Alberto Ruol; Ermanno Ancona Journal: Ann Surg Date: 2008-12 Impact factor: 12.969
Authors: Guilherme M Campos; Eric Vittinghoff; Charlotte Rabl; Mark Takata; Michael Gadenstätter; Feng Lin; Ruxandra Ciovica Journal: Ann Surg Date: 2009-01 Impact factor: 12.969