Laparoscopic Heller-Dor surgery for esophageal achalasia: impact of intraoperative real-time manometric feedback on postoperative outcomes.
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%).


CONCLUSIONS
Intraoperative manometry with real-time pressure feedback is a feasible, safe, and useful adjunct in LHD.
Endo
Shunji
S
Department of Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
Nakajima
Kiyokazu
K
Nishikawa
Kazuhiro
K
Takahashi
Tsuyoshi
T
Souma
Yoshihito
Y
Taniguchi
Eiji
E
Ito
Toshinori
T
Nishida
Toshirou
T
D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry / Q000379:methods; D016343:Monitoring, Intraoperative / Q000379:methods; D011028:Pneumoperitoneum, Artificial; D011183:Postoperative Complications / Q000517:prevention & control*; D011859:Radiography