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Surgical Endoscopy
Published in: Surgical Endoscopy 3/2017

01-03-2017

Mucosal perforation during laparoscopic surgery for achalasia: impact of preoperative pneumatic balloon dilation

Authors: Yoshihito Souma, Kiyokazu Nakajima, Eiji Taniguchi, Tsuyoshi Takahashi, Yukinori Kurokawa, Makoto Yamasaki, Yasuhiro Miyazaki, Tomoki Makino, Tetsuhiro Hamada, Jun Yasuda, Takeyoshi Yumiba, Shuichi Ohashi, Shuji Takiguchi, Masaki Mori, Yuichiro Doki

Published in: Surgical Endoscopy | Issue 3/2017

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Abstract

Background

Controversy remains whether preoperative pneumatic balloon dilation (PBD) influences the surgical outcome of laparoscopic esophagocardiomyotomy in patients with esophageal achalasia. The aim of this study was to evaluate whether preoperative PBD represents a risk factor for surgical complications and affects the symptomatic and/or functional outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD).

Methods

A retrospective chart review was conducted on a prospectively compiled surgical database of 103 consecutive patients with esophageal achalasia who underwent LHD from November 1994 to September 2014. The following data were compared between the patients with preoperative PBD (PBD group; n = 26) and without PBD (non-PBD group; n = 77): (1) patients’ demographics: age, gender, body mass index, duration of symptoms, maximum transverse diameter of esophagus; (2) operative findings: operating time, blood loss, intraoperative complications; (3) postoperative course: complications, clinical symptoms, postoperative treatment; and (4) esophageal functional tests: preoperative and postoperative manometric data and postoperative profile of 24-h esophageal pH monitoring.

Results

(1) No significant differences were observed in the patients’ demographics. (2) Operative findings were similar between the two groups; however, the incidence of mucosal perforation was significantly higher in the PBD group (n = 8; 30.7 %) compared to the non-PBD group (n = 6; 7.7 %) (p = 0.005). (3) Postoperative complications were not encountered in either group. The differences were not significant for postoperative clinical symptoms, the incidence of gastroesophageal reflux disease, or necessity of postoperative treatments. (4) Lower esophageal sphincter pressure was effectively reduced in both groups, and no differences were observed in manometric data or 24-h pH monitoring profiles between the two groups. Multivariate logistic regression analysis showed that preoperative PBD and the maximum transverse diameter of esophagus were significantly associated with intraoperative mucosal perforation.

Conclusions

Although postoperative outcomes were not affected, additional caution is recommended in identifying intraoperative mucosal perforation in patients with preoperative PBD when performing LHD.
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Metadata
Title
Mucosal perforation during laparoscopic surgery for achalasia: impact of preoperative pneumatic balloon dilation
Authors
Yoshihito Souma
Kiyokazu Nakajima
Eiji Taniguchi
Tsuyoshi Takahashi
Yukinori Kurokawa
Makoto Yamasaki
Yasuhiro Miyazaki
Tomoki Makino
Tetsuhiro Hamada
Jun Yasuda
Takeyoshi Yumiba
Shuichi Ohashi
Shuji Takiguchi
Masaki Mori
Yuichiro Doki
Publication date
01-03-2017
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 3/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-016-5133-1

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