Impact of the Myotomy Extent on Gastric Side on Surgical Outcome After Heller’s Cardiomotomy for Achalasia

Nakeeb, Ayman El; Ezzat, Helmy; Shehta, Ahmed; Gawad, Mohamed Abd El; El-Magd, El-Sayed Abou; Sorogy, Mohamed El; Elrefei, Mohamed; El-Geidi, Ahmed A; El-Hak, Nabil Gad

doi:10.1097/sle.0000000000000647

Cited by 7 publications

(2 citation statements)

References 25 publications

(37 reference statements)

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“…The length of myotomy in our study was 4-5 cm toward the esophageal side and 2-3 cm toward the stomach. Few studies have shown that the length of myotomy on the stomach >2.5 cm results in a greater degree of alleviation of dysphagia symptoms, albeit with a higher rate of reflux [9]. Others have shown benefits with an extended myotomy of 3 cm [10].…”

Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Suman¹,

Varshney²,

Soni³

et al. 2022

Cureus

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BackgroundHeller myotomy (HM) with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is controversial. In this study, we compared both types of fundoplication concerning subjective and objective parameters. MethodologyThis prospective comparative study comprised a total of 30 consecutive patients who underwent laparoscopic/robotic HM with either Dor fundoplication (DF) (n = 15) or Toupet fundoplication (TF) (n = 15). Preoperative baseline characteristics, intraoperative details, and postoperative complications were recorded. Patients were followed with Eckardt score, quality of life-related scores, 24-hour pH study, and highresolution manometry (HRM) at the one-year follow-up. ResultsThere was no significant difference between the two groups regarding preoperative baseline parameters, length of hospital stay, and postoperative complications. The HM+DF group had four (27%) patients with recurrence/failure with none in the HM+TF, but it was not significant (p = 0.79). Symptom scores were similar between the groups at six and 12 months of follow-up. One patient in the HM+DF group and two in the HM+TF group had significant pathological acid reflux (p = 0.483). On HRM, HM+TF showed a trend toward significance in terms of esophagogastric junction (EGJ) relaxation (p = 0.058) with a non-significant difference in median integrated relaxation pressure (p = 0.081). ConclusionsThe study showed a trend toward lower failure rates and improved EGJ relaxation with similar reflux rates in patients who underwent HM+TF compared to HM+DF. However, long-term follow-up is required to validate our findings with well-defined subjective and objective criteria.

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Section: Discussionmentioning

confidence: 99%

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Suman¹,

Varshney²,

Soni³

et al. 2022

Cureus

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“…It entails mechanical disruption of oesophagal and gastric muscle fibres leading to enhanced oesophagal emptying and relief of dysphagia. 11 To obtain such an outcome, all muscle fibres should be divided with complete exposure of the underlying mucosa. 6 As a result, an intraoperative mucosal injury could occur during this procedure.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors of Mucosal Injury During Laparoscopic Heller Cardiomyotomy

Seleem¹

2022

Al-Azhar International Medical Journal

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Background: Laparoscopic Heller cardiomyotomy has been widely adopted as a successful option for managing achalasia. However, intraoperative mucosal perforation is a common and dreadful complication of this technique. Aim of the study: We conducted this study to detect these possible risk factors for mucosal injury and to elucidate its impact on operative and post-operative outcomes. Patients and Methods: The data of consecutive 52 patients diagnosed with achalasia and subjected to laparoscopic Heller cardiomyotomy were retrospectively reviewed. They were allocated into two groups according to the occurrence of intraoperative mucosal injury: Group A (Noperforation group) and Group B (Perforation group). Results: Mucosal injury was detected in 9 patients (17.31%), and these patients were included in Group B, while the remaining cases were included in Group A. Most preoperative data were statistically comparable between the two groups, apart from age and history of previous balloon dilatation. The former was significantly older, whereas the latter was significantly higher in Group B. Mucosal perforation was associated with a significant increase in operative time and blood loss, and it was mainly performed by low-volume surgeons. Group B also showed a significant prolongation in the duration of hospitalization and more delay in oral start. Conclusion: Old age, previous balloon dilatation, and low surgical expertise are the main risk factors for mucosal injury during Heller cardiomyotomy. These factors should be considered when performing this operation, especially the history of previous dilatation. Patients with the previous risk factors should be performed with highly experienced surgeons.

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