Mucosal Perforation During Laparoscopic Heller Myotomy Has No Influence on Final Treatment Outcome.
The aims of the study were (a) to examine the final outcome in patients experiencing accidental mucosal perforation during laparoscopic Heller myotomy with Dor fundoplication (LHD) and (b) to evaluate whether perforation episodes might influence the way in which surgeons subsequently approached the LHD procedure.



We studied all consecutive patients that underwent LHD between 1992 and 2015. Patients were divided into two main groups: those who experienced an intraoperative mucosal perforation (group P) and those whose LHD was uneventful (group NP). Two additional groups were compared: group A, which consisted of patients operated by a given surgeon immediately before a perforation episode occurred, and group B, which included those operated immediately afterwards.



Eight hundred seventy-five patients underwent LHD; a mucosal perforation was detected in 25 patients (2.9 %), which was found unrelated to patients' symptom's score and age, radiological stage, manometric pattern, or the surgeon's experience. The median postoperative symptom score was similar for the two groups as the failure rate: 92 failures in group NP (10.8 %) and 4 in group P (16 %) (p = 0.34); moreover, symptoms recurred in 2 patients of group A (10 %) and 3 patients of group B (15 %) (p = 0.9).



Accidental perforation during LHD is infrequent and impossible to predict on the grounds of preoperative therapy or the surgeon's personal experience. Despite a longer surgical procedure and hospital stay, the outcome of LHD is much the same as for patients undergoing uneventful myotomy. A recent mucosal perforation does not influence the surgeon's subsequent performance.
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Renato
R
Salvador
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Lorenzo
L
Spadotto
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Giovanni
G
Capovilla
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Guerrino
G
Voltarel
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Elisa
E
Pesenti
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Cristina
C
Longo
Surgical Oncology Unit, Veneto Institute of Oncology (IOV IRCCS), Padova, Italy.
Francesco
F
Cavallin
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Loredana
L
Nicoletti
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Alberto
A
Ruol
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Michele
M
Valmasoni
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy.
Stefano
S
Merigliano
Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy. m.costantini@unipd.it.
Mario
M
Costantini
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004931:Esophageal Achalasia / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D000074434:Heller Myotomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000293:injuries*; D011184:Postoperative Period; D012008:Recurrence; D063189:Symptom Assessment; D016896:Treatment Outcome
Achalasia; Heller-Dor; Mucosal perforation; Myotomy
Ann Surg. 2008 Dec;248(6):986-93
19092343
J Gastrointest Surg. 2010 Sep;14(9):1453-8
20300876
Dig Dis Sci. 1999 Nov;44(11):2270-6
10573373
Dig Dis Sci. 1997 Jul;42(7):1354-61
9246028
J Gastrointest Surg. 2005 Dec;9(9):1332-9
16332491
Arch Surg. 2005 Sep;140(9):827-33; discussion 833-4
16172290
J Gastrointest Surg. 2014 Jan;18(1):106-11; discussion 112
24018591
Ann Surg. 2009 Jan;249(1):45-57
19106675
N Engl J Med. 2011 May 12;364(19):1807-16
21561346
Surgery. 2009 Oct;146(4):826-31; discussion 831-3
19789044
Arch Surg. 2003 May;138(5):490-5; discussion 495-7
12742951
J Gastrointest Surg. 2010 Nov;14(11):1635-45
20830530
World J Surg. 2015 Mar;39(3):713-20
25409838
Ann Surg. 1999 Oct;230(4):587-93; discussion 593-4
10522728
Ann Surg. 2004 Mar;239(3):364-70
15075653
J Am Coll Surg. 2009 Jan;208(1):151-62
19228517
Surg Endosc. 1999 Jun;13(6):576-9
10347294
J Am Coll Surg. 2009 Jun;208(6):1035-44
19476889
Surg Endosc. 2007 Jul;21(7):1184-9
17514399
J Gastrointest Surg. 2000 May-Jun;4(3):282-9
10769091
Surg Endosc. 1993 Sep-Oct;7(5):459-61
8211631
Ann Surg. 1997 Jun;225(6):655-64; discussion 664-5
9230806
J Gastrointest Surg. 2016 Jan;20(1):125-31; discussion 131
26519153
Ann Thorac Surg. 1996 Aug;62(2):327-30
8694585
Aliment Pharmacol Ther. 2010 Nov;32(10):1257-65
20955445
Am J Surg. 1997 Apr;173(4):308-11
9136786