Shunji Endo
   Department   Kawasaki Medical School  Kawasaki Medical School, Department of Digestive Surgery,
   Position   Associate Professor
Article types 原著
Language English
Peer review Peer reviewed
Title Laparoscopic Heller-Dor surgery for esophageal achalasia: impact of intraoperative real-time manometric feedback on postoperative outcomes.
Journal Formal name：Digestive surgery
Abbreviation：Dig Surg
ISSN code：14219883/02534886
Domestic / ForeginForegin
Volume, Issue, Page 26(4),pp.342-8
Author and coauthor Endo Shunji, Nakajima Kiyokazu, Nishikawa Kazuhiro, Takahashi Tsuyoshi, Souma Yoshihito, Taniguchi Eiji, Ito Toshinori, Nishida Toshirou
Authorship Lead author
Publication date 2009/10
Summary 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