Skip to main content
SpringerLink
Log in

Wound healing of laparoscopic esophageal myotomy with or without an added gastric patch

  • Original Article
  • Published:
Surgical Endoscopy And Other Interventional Techniques Aims and scope Submit manuscript

Abstract

Background:

The purpose of this research is to compare the wound healing of the laparoscopic esophagomyotomy with and without a gastric patch.

Methods:

Twelve male pigs were distributed into two groups of six animals. Esophagomyotomy was performed in group A. A gastric patch was associated to the myotomy in group B. On the 21st postoperative day, lumen molding was accomplished to determine the index of stenosis (IS) at the area of myotomy (AM). Macroscopic and microscopic aspects of wound healing were also studied at AM. Three microscopic morphologic patterns were defined for morphometric evaluation: leukocytes (constituted by polymorphonuclear and mononuclear cells), new endothelial cells, and collagen fibers.

Results:

There was a longer operative duration in group B (93.6 min) than in group A (45 min). At AM, IS was negative (lumen increased) and equivalent in both groups: −11.1% in group A and −12.7% in group B. Mesotelial epithelium covering RM was observed in group A. Inflammatory reaction was greater in group B in comparison with group A (leuCocytes: 22 cells versus 8.6; fibrosis: 25.5 fibers versus 15.6; granulation tissue: 18.7 vessels versus 9.7).

Conclusion:

Esophagomyotomy followed by gastric patch does not heal adequately and is worsened by the presence of foreign body granulomas around stitches. Myotomy without gastric patch is faster and causes lower inflammation. Myotomy alone or with gastric patch does not lead to esophageal stenosis at RM and does not lead to restoration of the esophageal musculature continuity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5

Similar content being viewed by others

References

  1. Azevedo JLMC, Boulez J (2001) Comparison between laparoscopic esophagocardiomyotomy with and without antireflux procedure in the treatment of achalasia. Surg Endosc 15(Suppl 1): S54

    Google Scholar 

  2. Bloomston M, Boyce W, Mamel J, Albrink M, Murr M, Durkin A, et al. (2000) Videoscopic Heller’s myotomy for achalasia—results beyond short-term follow-up. J Surg Res 92: 150–152

    Article  PubMed  Google Scholar 

  3. Boulez J, Meeus P, Espalieu P (1997) Oesocardiomyotomie de Heller sans anti-reflux par voie laparoscopique: analyse d’une série de 27 cas. Ann Chir 51: 232–236

    PubMed  Google Scholar 

  4. Collard JM, Romagnoli R, Lengele B, Salizzoni M, Kenstens PJ (1996) Heller-Dor procedure for achalasia: from conventional to video-endoscopic surgery. Acta Chir Belg 96: 62–65

    PubMed  Google Scholar 

  5. Delgado F, Bolufer JM, Martinez-Abad M, Martín J, Blanes F, Castro C, et al. (1996) Laparoscopic treatment of esophageal achalasia. Surg Laparosc Endosc 6: 83–90

    Article  PubMed  Google Scholar 

  6. Dempsey DT, Kalan MMH, Gerson RS, Parkman HP, Maier WP (1999) Comparison of outcomes following open and laparoscopic esophagomyotomy for achalasia. Surg Endosc 13: 747–750

    Article  PubMed  Google Scholar 

  7. Dor J, Humbert P, Dor V, Figarella J (1962) L’intérêt de la technique de Nissen modifiée dans la prévention du reflux après cardiomyotomie extra-muqueuse de Heller. Mém Acad Chir 88: 877–884

    Google Scholar 

  8. Ellis H, Gibb SP (1975) Reoperation after esophagomyotomy for achalasia of the esophagus. Am J Surg 129: 407–412

    Article  PubMed  Google Scholar 

  9. Hunter JG, Trus TL, Branum GD, Waring JP (1997) Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg 225: 655–664

    Article  PubMed  Google Scholar 

  10. Igci A, Müslümanoglu M, Dolay K , Yamaner S, Asoglu O, Avcic C. (1998) Laparoscopic esophagomyotomy without an antireflux procedure for the treatment of achalasia. J Laparoendosc Adv Surg Tech, 8(6): 409–416

    Google Scholar 

  11. Kjellin AP, Granqvist S, Ramel, Thor KBA (1999) Laparoscopic myotomy without fundoplication in patients with achalasia. Eur J Surg 165: 1162–1166

    Article  PubMed  Google Scholar 

  12. Lyass S, Thoman D, Steiner P, Phillips E (2003) Current status of an antireflux procedure in laparoscopic Heller myotomy. Surg Endosc 17: 554–558

    Article  PubMed  Google Scholar 

  13. McAdams AJ, Meikle AG, Taylor JO (1970) One layer or two layer colonic anastomoses? Am J Surg 120: 546–550

    PubMed  Google Scholar 

  14. Mitchell PC, Watson DI, Devitt PG, Briten-Jones R, MacDonald S, Myers JC, et al. (1995) Laparoscopic cardiomyotomy with a Dor patch for achalasia. Can J Surg 38:445–448

    PubMed  Google Scholar 

  15. Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230: 587–593

    Article  PubMed  Google Scholar 

  16. Peracchia A, Rosati R, Bona S, Fumagalli U, Bonavina L, Chella B (1995) Laparoscopic treatment of functional diseases of the esophagus. Int Surg 80: 336–340

    PubMed  Google Scholar 

  17. Pinotti HW, Felix VN, Domene CE, Purceli EL (1979) Recurrence of dysphagia in patients operated on for megaesophagus: analysis of determining factors. Chir Gastroenterol 13: 1–7

    Google Scholar 

  18. Raiser F, Perdikis G, Hinder RA, Swanstrom LL, Filipi CJ, McBride PJ, et al. (1996) Heller myotomy via minimal-access surgery: an evaluation of antireflux procedures. Arch Surg 131: 593–597

    PubMed  Google Scholar 

  19. Richards WO, Sharp KW, Holzman MD (2001) An antireflux procedure should not routinely be added to a Heller myotomy. J Gastrointest Surg 5: 13–16

    Article  PubMed  Google Scholar 

  20. Robertson GS, Lloyd DM, Wicks AC, Caestecker S, Veitch PS (1995) Laparoscopic Heller’s cardiomyotomy without an antireflux procedure. Br J Surg 82: 957–959

    PubMed  Google Scholar 

  21. Rosati R, Fumagalli U, Bona S, Bonavina L, Pagani M, Perachia A (1998) Evaluating results of laparoscopic surgery for esophageal achalasia. Surg Endosc 12: 270–273

    Article  PubMed  Google Scholar 

  22. Wang PC, Sharp KW, Holzman MD, Clements RH, Holcomb GW, Richards WO (1998) The outcome of laparoscopic Heller myotomy without antireflux procedure in patients with achalasia. Am Surg64: 515–521

    Google Scholar 

  23. Yamamura MS, Gilster JC, Myers BS, Denevey CW, Sheppard BC (2000) Laparoscopic Heller myotomy and anterior fundoplication for achalasia results in a high degree of patient satisfaction. Arch Surg 135: 902–906

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful for the financial support given by Fundo de Auxílio aos Docentes e Alunos (FADA) from Federal University of São Paulo—Escola Paulista de Medicina and the laparosopic material and equipment given by PCE—Pró-Cirurgia Especializada Ltda—Smith & Nephew, Inc. Parts of this article have been reviewed by Thomas Buckingham, Chief Editor of Life Sciences Publishing, USA.

Author information

Authors and Affiliations

  1. Division of Experimental Surgery, Department of Surgery, Federal University of São Paulo. R. Botucatu, 740—Prédio da Cirurgia Experimental—CEP, São Paulo, 04023-900, Brazil

    J. L. M. C. Azevedo, F. O. Kozu, C. E. P. Silva, A. A. Sorbello, A. Delorenzo & R. C. Pasqualin

  2. Department of Surgery, Hospital do Servidor Público, São Paulo, Brazil

    O. Azevedo, G. S. Aguiar & F. J. C. Menezes

  3. Department of Morphology, UNIFESP, Brazil

    M. d. J. Simões

Authors
  1. J. L. M. C. Azevedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. O. Kozu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Azevedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. E. P. Silva
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. A. Sorbello
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. d. J. Simões
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. Delorenzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. R. C. Pasqualin
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G. S. Aguiar
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. F. J. C. Menezes
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. L. M. C. Azevedo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Azevedo, J., Kozu, F., Azevedo, O. et al. Wound healing of laparoscopic esophageal myotomy with or without an added gastric patch. Surg Endosc 19, 1320–1324 (2005). https://doi.org/10.1007/s00464-004-2082-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-004-2082-x

Keywords:

Search

Navigation