エンドウ シュンジ   Shunji Endo
  遠藤 俊治
   所属   川崎医科大学  医学部 臨床医学 消化器外科学
   職種   准教授
論文種別 原著
言語種別 英語
査読の有無 査読あり
表題 Laparoscopic Heller-Dor surgery for esophageal achalasia: impact of intraoperative real-time manometric feedback on postoperative outcomes.
掲載誌名 正式名:Digestive surgery
略  称:Dig Surg
ISSNコード:14219883/02534886
掲載区分国外
巻・号・頁 26(4),pp.342-8
著者・共著者 Endo Shunji, Nakajima Kiyokazu, Nishikawa Kazuhiro, Takahashi Tsuyoshi, Souma Yoshihito, Taniguchi Eiji, Ito Toshinori, Nishida Toshirou
担当区分 筆頭著者
発行年月 2009/10
概要 BACKGROUND:Laparoscopic Heller myotomy with Dor fundoplication (LHD) is one of the most established surgical procedures for esophageal achalasia. Preoperative esophageal manometry has been reported as useful to evaluate lower esophageal sphincter (LES) pressure. However, the feasibility, safety, and impact of its intraoperative use have not been fully evaluated, especially when enhanced with real-time 3-D pressure imaging.METHODS:LHD was attempted on 24 consecutive patients with esophageal achalasia. Manometry was performed at 3 time points during LHD: before myotomy, after myotomy, and after fundoplication. Investigations included esophagography, manometry, and 24-hour esophageal pH monitoring in the preoperative, short-term (0-5 months) and long-term (1-3 years) follow-up periods.RESULTS:The 3-D intraoperative manometric images were presented to the surgical crew on a monitor screen immediately after each measurement in all attempted cases (n = 13). Any residual high pressure zone of the LES was easily recognized and resolved with additional myotomy. Postoperative esophagographies showed resolution of esophageal dilatation. Manometric examination revealed significant reduction of LES pressure in the short-/long-term follow-up periods. PH monitoring showed no increase in acid reflux. Overall outcomes were satisfactory (symptom relief = 95%).CONCLUSION:Intraoperative manometry with real-time pressure feedback is a feasible, safe, and useful adjunct in LHD.
DOI 10.1159/000244512
PMID 19816021