Laparoscopic hand-sewn cardioplasty: an alternative procedure for end-stage achalasia
| Autor: | Lalin Navaratne, Alberto Martínez-Isla, Asunción Acosta-Mérida, Fátima Senra, Stuart Gould |
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| Rok vydání: | 2021 |
| Předmět: |
Myotomy
medicine.medical_specialty medicine.medical_treatment Perforation (oil well) Cardioplasty Fundoplication Achalasia How-I-Do-It articles Intraoperative endoscopy otorhinolaryngologic diseases medicine Humans Laparoscopy Digestive System Surgical Procedures Retrospective Studies medicine.diagnostic_test business.industry Vascular surgery medicine.disease Surgery Cardiac surgery Esophageal Achalasia Treatment Outcome Lower oesophageal sphincter Cardiothoracic surgery business Abdominal surgery |
| Zdroj: | Langenbeck's Archives of Surgery |
| ISSN: | 1435-2451 1435-2443 |
| DOI: | 10.1007/s00423-021-02117-9 |
| Popis: | Background Primary achalasia is a rare oesophageal motor disorder characterized by the absence of swallow-induced relaxation of the lower oesophageal sphincter and diminished or absent oesophageal body peristalsis. Around 5% of these patients will develop end-stage achalasia, where oesophagectomy may be advocated. We present the laparoscopic hand-sewn cardioplasty as an alternative ‘oesophagus-preserving’ procedure in patients with end-stage achalasia. Methods We present a retrospective review of four patients who underwent laparoscopic hand-sewn cardioplasty. Data collected included pre-operative demographic information and investigations; and post-operative outcomes. Patients were scored pre- and post-operatively using Reflux Symptom Index, Eating Assessment Tool-10 and Voice Handicap Index-10 questionnaires. Results Four patients underwent laparoscopic hand-sewn cardioplasty during the study period. In one patient, it was performed as a rescue procedure during attempted myotomy following multiple perforations of friable mucosa. In the other three patients, laparoscopic hand-sewn cardioplasty was performed for end-stage achalasia. None of the patients had post-operative complications and all patients were discharged on the second post-operative day. All patients experienced improvement in swallowing symptoms (EAT-10; p = 0.03) but developed post-operative gastroesophageal reflux. Conclusion To our knowledge, this is the first published case series of laparoscopic hand-sewn cardioplasty for end-stage achalasia. It appears to be a safe and effective procedure for the treatment of end-stage achalasia, offering an alternative minimally invasive procedure to oesophagectomy. Laparoscopic hand-sewn cardioplasty can also be used as a ‘rescue’ procedure during myotomy in patients who have poor-quality mucosa which perforates intra-operatively or is at high risk of perforation/leaking post-operatively. |
| Databáze: | OpenAIRE |
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