Laparoscopic Heller’s Myotomy for Achalasia Cardia by Blunt Dissection: a Safe Technique

Parasar, Kunal; Nag, Hirdaya Hulas; Govind, S Hari; Sachdeva, Sanjeev

doi:10.1007/s12262-017-1688-x

Cited by 1 publication

(3 citation statements)

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“…[ 16 ] Sharp dissection technique using electrocautery has been used in most of these studies; however, our study has shown the feasibility of BDT of oesophageal myotomy without using electrocautery or harmonic scalpel with long-term results comparable to historical cohorts. [ 7 ]…”

Section: Discussionmentioning

confidence: 99%

“…The port positions and technique were the same as described earlier. [ 7 ] The lower end of the oesophagus was mobilised, and posterior dissection to loop the oesophagus was done only in patients with difficult dissection and/or in patients with short intra-abdominal oesophagus [ Figure 5 ]. After adequate exposure, BDT was used to perform myotomy, which was extended up to 5–6 cm of the lower oesophagus and 2–3 cm of the proximal stomach [ Figure 6 ].…”

Section: Methodsmentioning

confidence: 99%

“…[ 6 ] We earlier reported our early experience regarding myotomy using blunt dissection technique (BDT). [ 7 ] We hereby present the long-term outcomes of 100 consecutive patients of AC who underwent LHM with BDT.…”

Section: Introductionmentioning

confidence: 99%

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The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique

Chauhan

Nekarakanti

Burad

et al. 2023

Journal of Minimal Access Surgery

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Background: Laparoscopic Heller myotomy (LHM) can be performed by blunt dissection technique (BDT). Only a few studies have assessed long-term outcomes and relief of dysphagia following LHM. The study reviews our long-term experience following LHM by BDT. Methods: This retrospective study was analysed from a prospectively maintained database (from 2013 to 2021) of a single unit of the Department of Gastrointestinal Surgery at G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. The myotomy was performed by BDT in all patients. A fundoplication was added in selected patients. Post-operative Eckardt score >3 was considered treatment failure. Results: A total of 100 patients underwent surgery during the study period. Of them, 66 patients underwent LHM, 27 underwent LHM with Dor fundoplication and 7 underwent LHM with Toupet fundoplication. The median length of myotomy was 7 cm. The mean operative time was 77 ± 29.27 min and the mean blood loss of 28.05 ± 16.06 ml. Five patients had intraoperative oesophageal perforation. The median length of hospital stay was 2 days. There was no hospital mortality. The post-operative integrated relaxation pressure (IRP) was significantly lower than the mean pre-operative IRP (9.78 vs. 24.77). Eleven patients developed treatment failure, of which ten patients presented with recurrence of dysphagia. There was no difference in symptom-free survival amongst various types of achalasia cardia (P = 0.816). Conclusion: LHM performed by BDT has a 90% success rate. Complication using this technique is rare, and recurrence post-surgery can be managed with endoscopic dilatation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%