Comparison between Laparoscopic Esophago-Cardiomyotomy with and without Antireflux Procedure in the Treatment of Achalasia

Wound healing of laparoscopic esophageal myotomy with or without an added gastric patch

“…There are authors who judge it essential to apposc a gastric patch in the wound surface of a laparoscopic myotomy [2, 4-6, 9, 14-17, 23] contrast, others understand it to be preferable to dispense with the association of any antireflux procedure to the laparoscopic myotomy, in selected cases [1,3,10,11,19,20,22].…”

“…Specifically related to the benefits of the application of gastric patch on the wound area [8,17,21], contrary arguments point to difficulties in the reabsorption of inflammatory exudates confined by gastric patch, which increase fibrosis in that region [1][2][3]. If in free peritoneum, exudates were soon being absorbed, favoring epithelialization of wound by mesothelial cells.…”

“…If in free peritoneum, exudates were soon being absorbed, favoring epithelialization of wound by mesothelial cells. In such a case, the wound is not isolated from the peritoneal fluid by means of an applied gastric patch [1][2][3].…”

“…Additionally, magnification of the operative surgical area must show possible iatrogenic microperforations that could be seen even more accurately by using methylene blue and gas injection [1][2][3]. Further, it should be kept in mind that the muscular tone of sectioned circular esophageal musculature tends to cause a deviation of myotomy edges in such a way that the reapproximation risk is avoided [1,3].…”

“…Further, it should be kept in mind that the muscular tone of sectioned circular esophageal musculature tends to cause a deviation of myotomy edges in such a way that the reapproximation risk is avoided [1,3].…”