Outcome after perforation sustained during pneumatic dilatation for achalasia
- 24 Downloads
- 21 Citations
Abstract
Although esophageal perforation complicates about 5% of pneumatic dilatations performed for achalasia, little is known about associated hospital and long-term courses. In order to assess the outcome of such patients undergoing emergency surgery for repair, records of seven patients sustaining perforation during pneumatic dilatation were compared to those of five patients undergoing elective myotomy during the same period. In perforation patients, mean intervals following the procedure were 3.6 hr to administration of antibiotics and 9.6 hr to surgery. The perforation and elective myotomy groups had similar mean durations of operation (3.8 vs 3.3 hr), intensive care stays (2 vs 1 days) and hospitalization (12 vs 11 days); perforation patients had a significantly longer mean interval from surgery to oral intake (7 vs 5 days). Postdischarge long-term outcomes were alike in the groups. It is concluded that patients with perforation from pneumatic dilatation that is recognized and treated promptly have outcomes that are comparable to those of patients who undergo elective myotomy.
Key Words
achalasia esophageal perforation pneumatic dilatation esophagomyotomy endoscopic complicationsPreview
Unable to display preview. Download preview PDF.
References
- 1.Michel L, Grillo HC, Malt RA: Esophageal perforation. Ann Thorac Surg 33:203–210, 1982Google Scholar
- 2.Sarr MG, Pemberton JH, Payne WS: Management of instrumental perforations of the esophagus. J Thorac Cardiovasc Surg 84:211–218, 1982Google Scholar
- 3.Moghissi K, Pender D: Instrumental perforations of the oesophagus and their management. Thorax 43:642–646, 1988Google Scholar
- 4.Michel L, Grillo HC, Malt RA: Operative and nonoperative management of esophageal perforations. Ann Surg 194:57–63, 1981Google Scholar
- 5.Flynn AE, Verrier ED, Way LW, Thomas AN, Pellegrini CA: Esophageal perforation. Arch Surg 124:1211–1215, 1989Google Scholar
- 6.Bladergroen MR, Lowe JE, Postlethwait RW: Diagnosis and recommended management of esophageal perforation and rupture. Ann Thorac Surg 42:235–239, 1986Google Scholar
- 7.Goldstein LA, Thompson WR: Esophageal perforations: A 15 year experience. Am J Surg 143:495–503, 1982Google Scholar
- 8.Sauer L, Pellegrini CA, Way LW: The treatment of achalasia. A current perspective. Arch Surg 124:929–932, 1989Google Scholar
- 9.Reynolds JC, Parkman HP: Achalasia. Gastroenterol Clin North Am 18:223–255, 1989Google Scholar
- 10.Ferguson MK: Achalasia: Current evaluation and therapy. Ann Thorac Surg 52:336–342, 1991Google Scholar
- 11.Vantrappen G, Hellemans J: Treatment of achalasia and related motor disorders. Gastroenterology 79:144–154, 1980Google Scholar
- 12.Richter JE: Surgery or pneumatic dilatation for achalasia: A head-to-head comparison. Now are all the questions answered. Gastroenterology 97:1340–1341, 1989Google Scholar
- 13.Swedlund A, Traube M, Siskind BN, McCallum RW: Nonsurgical management of esophageal perforation from pneumatic dilatation in achalasia. Dig Dis Sci 34:379–384, 1989Google Scholar
- 14.McKinnon WMP, Ochsner JL: Immediate closure and Heller procedure after Mosher bag rupture of the esophagus. Am J Surg 127:115–118, 1974Google Scholar
- 15.Slater G, Sicular AA: Esophageal perforations after forceful dilatation in achalasia. Ann Surg 195:186–188, 1982Google Scholar
- 16.Miller RE, Tiszenkel HI: Esophageal perforation due to pneumatic dilatation for achalasia. Surg Gynecol Obstet 166:458–460, 1988Google Scholar
- 17.Rosato EF, Acker M, Curcillo PG Jr, Reilly R, Reynolds J: Transabdominal esophagomyotomy and partial fundoplication for treatment of achalasia. Surg Gynecol Obstet 173:137–141, 1991Google Scholar
- 18.Tulman AB, Boyce HW Jr: Complications of esophageal dilatation and guidelines for prevention. Gastrointest Endosc 27:229–234, 1981Google Scholar
- 19.Okike N, Payne WS, Neufeld DM, Bernatz PE, Pairolero PC, Sanderson DR: Esophagomyotomy versus forceful dilation for achalasia of the esophagus: Results in 899 patients. Ann Thorac Surg 28:119–124, 1979Google Scholar
- 20.Csendes A, Braghetto I, Henríquez A, Cortés C: Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut 30:299–304, 1989Google Scholar