title: Distal esophageal perforation repair during laparoscopic esophagomyotomy: evaluation of outcomes and review of surgical technique.
abstract: OBJECTIVE
  To describe the technique employed and our experience with primary laparoscopic repair of distal esophageal perforations produced during laparoscopic esophagomyotomy, as well as to evaluate the outcomes.
  
  
  METHODS
  We analyzed six cases of patients with primary achalasia in whom distal esophageal mucosal perforations were caused during laparoscopic esophagomyotomy. A primary repair and fundoplication was performed in five cases; in the sixth patient, the perforation could not be recognized during the surgical procedure. The postoperative follow-up included clinical evaluation, upper gastrointestinal endoscopy, esophageal manometry, and ambulatory 24-h esophageal pH monitoring.
  
  
  RESULTS
  Five patients reported dysphagia relief and were highly satisfied with the final surgical outcome. In one case we observed an altered postoperative 24-h esophageal pH. Two patients developed esophageal leakage, one with a fatal outcome.
  
  
  CONCLUSIONS
  The primary repair of distal esophageal perforations during laparoscopic esophagomyotomy is a valid therapeutic option and does not alter the surgical purpose. However, if the perforation is not recognized early on, the prognosis can change.
authors.affiliation: Endoscopic Surgery Division, Hospital General Dr. Manuel Gea González, Mexico City, Mexico. pfreddy@telcel.net.ve
authors.forename: Freddy
authors.initials: F
authors.lastname: Pereira-Graterol
authors.forename: Mucio
authors.initials: M
authors.lastname: Moreno-Portillo
mesh_terms: D000328:Adult; D000368:Aged; D004931:Esophageal Achalasia / Q000601:surgery*; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013536:Suture Techniques; D016896:Treatment Outcome