Local epinephrine facilitates laparoscopic Heller myotomy

Kuster, Gustavo G. R.

doi:10.1007/s004649900600

Cited by 7 publications

(3 citation statements)

References 15 publications

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“…There also is bulging of the mucosa at the LES area. Injection of dilute epinephrine into the muscle before myotomy may be useful, because it minimizes bleeding and allows for better visualization of the mucosa [42].…”

Section: Brief Description Of Myotomy Techniquementioning

confidence: 99%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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PreambleThe guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive techniques for the treatment of achalasia in specific clinical circumstances. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used to treat this condition. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth. DisclaimerClinical practice guidelines are intended to indicate the best available approach to medical conditions as established by a systematic review of available data and expert opinion. The approach suggested may not necessarily be the only acceptable approach given the complexity of the healthcare environment. These guidelines are intended to be flexible, because the surgeon must always choose the approach best suited to the individual patient and variables in existence at the moment of decision. These guidelines are applicable to all physicians who are appropriately credentialed and address the clinical situation in question, regardless of specialty.Guidelines are developed under the auspices of SAGES-the guidelines committee-and are approved by the Board of Governors. The recommendations of each guideline undergo multidisciplinary review and are considered valid at the time of production based on the data available. New developments in medical research and practice pertinent to each guideline are reviewed, and guidelines will be periodically updated. Literature review methodA systematic literature search was performed on MED-LINE in October 2010. The search strategy was limited to adult English language articles and is shown in Fig. 1.We identified 214 relevant articles. The abstracts were reviewed by four committee members (DS, WR, TMF, and GPK) and divided into the following categories:(a) Randomized studies, meta-analyses, and systematic reviews and Other Interventional Techniques (b) Prospective studies (c) Retrospective studies (d) Case reports (e) Review articlesRandomized controlled trials, meta-analyses, and systematic reviews were selected for further review along with prospective and retrospective studies that included at least 50 patients. Studies with smaller samples were considered when additional evidence was lacking. The most recent reviews also were included. All case reports, old reviews, and smaller studies were excluded. According to these exclusion criteria, 102 articles were selected for review. Whenever the available evidence from Level I studies was considered to be adequate, lower evidence level studies were not considered.The reviewers graded the level of evidence and manually searched the bibliography of each article for additional articl...

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Section: Brief Description Of Myotomy Techniquementioning

confidence: 99%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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“…9 Perforation rates of 15–25%, however, are reported from several large laparoscopic series, 12,17,21,27 suggesting that the incidence of perforation is higher for LHM. Methods to reduce the rate of perforation have included the use of adrenaline in the submucosal plane 28 and the use of special scissors. 11 But the most important aspect of perforation is intraoperative recognition and adequate repair, in which case patient outcome does not appear to be affected.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Heller Myotomy For Achalasia

Hunt

Wills

2000

Aust. N.Z. J. Surg.

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“…Recently, the use of removable self‐expanding metal stents has been proposed (see Dysphagia) 110 . The results of a number of open and laparoscopic operations have been reported 111 –115 . In a randomized study comparing dilatation with esophagocardiomyotomy plus esophagofundopexy in 40 patients, the results of either treatment were similar with the exception of reduction in lower esophageal sphincter pressure, which was greater in the surgical group 116 .…”

Section: Esophageal Motilitymentioning

confidence: 99%