Risk Factors of Mucosal Injury During Laparoscopic Heller Cardiomyotomy

Abstract

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.