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