title: Laparoscopic Heller myotomy and fundoplication: findings and predictive value of early postoperative radiographic studies.
abstract: BACKGROUND
  We describe the findings on esophagography, the frequency and appearance of leaks after laparoscopic Heller myotomy and fundoplication, and the utility of early postoperative studies for predicting clinical outcome.
  
  
  METHODS
  Our study group consisted of 40 patients who underwent laparoscopic Heller myotomy and fundoplication in whom radiographic studies were performed during the early postoperative period. The radiographic reports and images were reviewed to determine the esophageal diameter, visualization or nonvisualization of the wrap, and the presence or absence of a leak. The esophageal diameter subsequently was correlated with the clinical findings to determine whether this was a useful parameter for predicting clinical outcome.
  
  
  RESULTS
  Two patients (5%) had small, sealed-off leaks on radiographic studies, and four (10%) had pseudo-leaks resulting from trapping of contrast material alongside the fundoplication wrap. Twelve (60%) of 20 patients with a dilated esophagus had esophageal symptoms on short-term follow-up versus three (15%) of 20 with a normal-caliber esophagus (p = 0.008), and five (56%) of nine patients with a dilated esophagus had symptoms on long-term follow-up versus six (43%) of 14 with a normal-caliber esophagus (p = 0.68).
  
  
  CONCLUSIONS
  Radiographic studies are useful for showing leaks after laparoscopic Heller myotomy and fundoplication, but radiologists should differentiate true leaks from trapping of contrast material alongside the fundoplication wrap. The caliber of the esophagus on early postoperative studies is also a useful parameter for predicting short-term clinical outcome in these patients.
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
authors.forename: C
authors.initials: C
authors.lastname: Yoo
authors.forename: M S
authors.initials: MS
authors.lastname: Levine
authors.forename: R O
authors.initials: RO
authors.lastname: Redfern
authors.forename: I
authors.initials: I
authors.lastname: Laufer
authors.forename: J
authors.initials: J
authors.lastname: Buyske
mesh_terms: D004931:Esophageal Achalasia / Q000601:surgery*; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011859:Radiography