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01-12-2016 | Original Article

Mucosal Perforation During Laparoscopic Heller Myotomy Has No Influence on Final Treatment Outcome

Authors: Renato Salvador, Lorenzo Spadotto, Giovanni Capovilla, Guerrino Voltarel, Elisa Pesenti, Cristina Longo, Francesco Cavallin, Loredana Nicoletti, Alberto Ruol, Michele Valmasoni, Stefano Merigliano, Mario Costantini

Published in: Journal of Gastrointestinal Surgery | Issue 12/2016

Abstract

Background

The aims of the study were (a) to examine the final outcome in patients experiencing accidental mucosal perforation during laparoscopic Heller myotomy with Dor fundoplication (LHD) and (b) to evaluate whether perforation episodes might influence the way in which surgeons subsequently approached the LHD procedure.

Methods

We studied all consecutive patients that underwent LHD between 1992 and 2015. Patients were divided into two main groups: those who experienced an intraoperative mucosal perforation (group P) and those whose LHD was uneventful (group NP). Two additional groups were compared: group A, which consisted of patients operated by a given surgeon immediately before a perforation episode occurred, and group B, which included those operated immediately afterwards.

Results

Eight hundred seventy-five patients underwent LHD; a mucosal perforation was detected in 25 patients (2.9 %), which was found unrelated to patients’ symptom’s score and age, radiological stage, manometric pattern, or the surgeon’s experience. The median postoperative symptom score was similar for the two groups as the failure rate: 92 failures in group NP (10.8 %) and 4 in group P (16 %) (p = 0.34); moreover, symptoms recurred in 2 patients of group A (10 %) and 3 patients of group B (15 %) (p = 0.9).

Conclusions

Accidental perforation during LHD is infrequent and impossible to predict on the grounds of preoperative therapy or the surgeon’s personal experience. Despite a longer surgical procedure and hospital stay, the outcome of LHD is much the same as for patients undergoing uneventful myotomy. A recent mucosal perforation does not influence the surgeon’s subsequent performance.

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Title: Mucosal Perforation During Laparoscopic Heller Myotomy Has No Influence on Final Treatment Outcome
Authors: Renato Salvador
Lorenzo Spadotto
Giovanni Capovilla
Guerrino Voltarel
Elisa Pesenti
Cristina Longo
Francesco Cavallin
Loredana Nicoletti
Alberto Ruol
Michele Valmasoni
Stefano Merigliano
Mario Costantini
Publication date: 01-12-2016
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 12/2016
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-016-3276-y

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Springer Medicine

Mucosal Perforation During Laparoscopic Heller Myotomy Has No Influence on Final Treatment Outcome

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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