title: Intraoperative upper GI endoscopy ensures an adequate laparoscopic Heller's myotomy.
abstract: BACKGROUND
  In this article, we present our case series of laparoscopic Heller's myotomies. These were all performed with the aid of intraoperative upper gastrointestinal (GI) endoscopy.
  
  
  METHODS
  During a 7-year period, 5 patients underwent a laparoscopic Heller's myotomy. There were 4 male patients and 1 female, with an average age of 12.1 years at operation (range, 9.3-14.9). One 14-year-old boy had had a laparoscopic Heller's procedure performed elsewhere and presented with severe dysphagia while undergoing orthopedic surgery in our hospital. His myotomy had been inadequate, and an intraoperative endoscopy had not been performed. All patients had preoperative upper GI contrast studies performed to confirm the diagnosis of achalasia. Two patients had manometry in addition to the contrast study. One patient had been treated with balloon dilatation preoperatively and another with botox injections. Endoscopy was performed pre- and postmyotomy to ensure adequacy.
  
  
  RESULTS
  There were no cases of intraoperative mucosal perforation or conversions to an open procedure. Sixty percent of patients required extension of the myotomy after intraoperative endoscopy. All patients had an uneventful, complication-free postoperative recovery.
  
  
  CONCLUSIONS
  We feel that the addition of endoscopy during laparoscopic Heller's myotomy confers a significant advantage in ensuring that the myotomy is adequate. In our experience, the outcome has been excellent even after previous balloon dilatation or submucosal botox injections.
authors.affiliation: Department of Pediatric Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom.
authors.forename: Boma T
authors.initials: BT
authors.lastname: Adikibi
authors.forename: Gordon A
authors.initials: GA
authors.lastname: MacKinlay
authors.forename: Fraser D
authors.initials: FD
authors.lastname: Munro
authors.forename: Lucy R
authors.initials: LR
authors.lastname: Khan
authors.forename: Peter M
authors.initials: PM
authors.lastname: Gillett
mesh_terms: D000293:Adolescent; D002648:Child; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods; D006801:Humans; D007432:Intraoperative Period; D010535:Laparoscopy