Laparoscopic Heller's cardiomyotomy in achalasia. Is intraoperative endoscopy useful, and why?
BACKGROUND
Inappropriate length of the myotomy incision along the stomach, the most common technical fault during Heller's cardiomyotomy, is related to the difficulty of identifying the gastro-esophageal junction, in particular during laparoscopic surgery. The goal of this study was to evaluate the contribution of endoscopy to gastro-esophageal junction identification during laparoscopic Heller's cardiomyotomy.


METHODS
In a group of 19 patients with intraoperative endoscopy with laparoscopic Heller's cardiomyotomy, surgical and endoscopic criteria for gastro-esophageal junction identification have been assessed. Then postoperative results of this group were compared with those of another group of 16 patients previously operated on without intraoperative endoscopy.


RESULTS
Endoscopic and laparoscopic criteria for gastro-esophageal junction identification were discordant in 11 patients (11/19, 58%). The cardia was in all these cases at a more distal site with endoscopic criteria. Complications ascribable to suboptimal technique were more frequent in the group without intraoperative endoscopy (7/16 patients) than in the other group (2/19 patients).


CONCLUSIONS
Endoscopy during laparoscopic Heller's cardiomyotomy is of great assistance in identifying the cardia, and thereby could improve surgical outcomes.
Alves
A
A
Medicosurgical Digestive Disease Unit, Montsouris Institute, Paris 6 University, 6 place de Port au Prince, 75013 Paris, France.
Perniceni
T
T
Godeberge
P
P
Mal
F
F
Lévy
P
P
Gayet
B
B
D002299:Cardia / Q000601:surgery; D016022:Case-Control Studies; D004931:Esophageal Achalasia / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged