Abstract
Background
This study aimed to evaluate the clinical utility of routine barium esophagram after laparoscopic anterior esophageal myotomy for achalasia.
Methods
The records of 260 consecutive patients who underwent laparoscopic anterior esophageal myotomy for achalasia from May 1996 to August 2007 were reviewed from a prospective institutional review board–approved database. Data are given as mean ± standard deviation. Statistical significance (p < 0.05) was determined using a two-tailed t-test and Fisher’s exact test.
Results
Routine protocol barium esophagrams performed for 236 patients a mean of 1 ± 0.3 days postoperatively were interpreted for 145 (61.4%) of the patients as normal flow of contrast after esophageal myotomy. There were no false-negative studies in this group, and diet was initiated without incident at a mean of 1 ± 0.2 days. The time to the goal diet was 1.3 ± 0.7 postoperative days, and the mean postoperative time to discharge was 1.5 ± 1 days. Of the 236 patients, 91 (38.6%) had an abnormal barium esophagram (contrast retention or pooling, delayed emptying). For this group, initiation of a diet was delayed for only six (6.6%) patients. Two barium esophagrams (0.9%) interpreted as an esophageal leak were determined to be false-positives after the one patient underwent negative exploratory laparoscopy and the other was observed clinically. In this group, diet was initiated at a mean of 1.1 ± 0.3 days. The time to the goal diet was 1.4 ± 0.7 days, and the mean postoperative time to discharge was 1.8 ± 1.9 days. The mean times to diet initiation, goal diet, and discharge were not significantly different (p ≥ 0.14) between the normal and the abnormal barium esophagram groups. The sensitivity and specificity of an abnormal routine barium esophagram after laparoscopic esophageal myotomy were, respectively, 100% and 62.0%, and the positive and negative predictive values were 2.2% and 100%.
Conclusions
Because of its poor positive predictive value, routine barium esophagram after laparoscopic anterior esophageal myotomy should be used selectively in the immediate postoperative period after an uncomplicated procedure.
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References
Mearin F, Mourelle M, Guarner F, Papo M, Balboa A, Malagelada JR (1993) Patients with achalasia lack nitric oxide synthase in the gastroesophageal junction. Eur J Clin Invest 23:724–728
Murray JA, Ledlow A, Launspach J, Evans D, Loveday M, Conkin JL (1995) The effects of recombinant human hemoglobin on esophageal motor function in humans. Gastroenterology 109:1241–1248
Sifrim D, Janssens J, Vantrappen G (1994) Failing deglutitive inhibition in primary esophageal motility disorders. Gastroenterology 106:875–882
Rosen MJ, Novitsky YW, Cobb WS, Kercher KW, Heniford BT (2007) Laparoscopic Heller myotomy for achalasia in 101 patients: can successful symptomatic outcomes be predicted? Surg Innov 14:177–183
Payne WS (1989) Heller’s contribution to the surgical treatment of achalasia of the esophagus. Ann Thorac Surg 48:876–881
Iqbal A, Haider M, Desai K, Garg N, Kavan J, Mittal S, Filipi CJ (2006) Technique and follow-up of minimally invasive Heller myotomy for achalasia. Surg Endosc 20:394–401
Patti MG, Pellegrini C, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks T, Way LW (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230:587–594
Rosati R, Fumagalli U, Bona S, Bonavina L, Pagani M, Peracchia A (1998) Evaluating results of laparoscopic surgery for esophageal achalasia. Surg Endosc 12:270–273
Vogt D, Curet M, Pitcher D, Josloff R, Milne RL, Zucker K (1997) Successful treatment of esophageal achalasia with laparoscopic Heller myotomy and toupet fundoplication. Surgery 174:709–714
Yoo C, Levine MS, Redfern RO, Laufer I, Buyske J (2004) Laparoscopic Heller myotomy and fundoplication: findings and predictive value of early postoperative radiographic studies. Abdom Imaging 29:643–647
Zaninotto G, Constantini M, Molena D, Buin F, Carta A, Nicoletti L, Ancona E (2000) Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg 4:282–289
Patti MG, Fisichella P (2008) Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia: how I do it. J Gastrointest Surg 12:764–766
Luckey AE, DeMeester SR (2006) Complications of achalasia surgery. Thorac Surg Clin 16:95–98
Portale G, Constantini M, Rizzetto C, Guirroli E, Ceolin M, Salvador R, Ancona E, Zaninotto G (2005) Long-term outcome of laparoscopic Heller–Dor surgery for esophageal achalasia: possible detrimental role of previous endoscopic treatment. J Gastrointest Surg 9:1332–1339
Bertucci W, White S, Yadegar J, Patel K, Han SH, Blocker O, Frickel D, Kadell B, Mehran A, Gracia C, Dutson E (2006) Routine postoperative upper gastroesophageal imaging is unnecessary after laparoscopic Roux-en-Y gastric bypass. Am Surg 72:862–864
Doraiswamy A, Rasmussen JJ, Pierce J, Fuller W, Ali MR (2007) The utility of routine postoperative upper GI series following laparoscopic gastric bypass. Surg Endosc 21:159–162
Ganci-Cerrud G, Hererra MF (1999) Role of radiologic contrast studies in the early postoperative period after bariatric surgery. Obes Surg 9:532–534
Kolakowski S, Kirkland M, Schuricht AL (2007) Routine postoperative upper gastrointestinal series after Roux-en-Y gastric bypass. Arch Surg 142:930–934
Goel AK, Sinha S, Chattopadhyay TK (1995) Role of gastrograffin study in the assessment of anastomotic leaks from cervical oesophagogastric anastomosis. Aust N Z J Surg 65:8–10
Tirnaksiz MB, Deschamps C, Allen MS, Johnson DC, Pairolero PC (2005) Effectiveness of screening aqueous contrast swallow in detecting clinically significant anastomotic leaks after esophagectomy. Eur Surg Res 37:123–128
Singh R, Fisher BL (2003) Sensitivity and specificity of postoperative upper GI series following gastric bypass. Obes Surg 13:73–75
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Melman, L., Quinlan, J.A., Hall, B.L. et al. Clinical utility of routine barium esophagram after laparoscopic anterior esophageal myotomy for achalasia. Surg Endosc 23, 606–610 (2009). https://doi.org/10.1007/s00464-008-9995-8
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DOI: https://doi.org/10.1007/s00464-008-9995-8