Abstract
Current management of esophageal perforation after pneumatic dilation for achalasia is thoracotomy and repair with myotomy. This study aims to assess the outcome of patients managed by laparotomy, and the role of laparoscopic repair. The study was carried out by means of retrospective case review and prospective follow-up with a symptom questionnaire. Results were compared with results in patients undergoing elective Heller myotomy. Over a 20-year period, 445 dilations for achalasia were performed in 371 patients. There were 10 esophageal perforations. Nine patients were referred for surgery and were successfully managed with a transabdominal repair. Laparoscopic repair was attempted in four patients but was successful in only one because of the perforation site. After a mean follow-up of 5.4 years, grade 1 or 2 Visick scores were recorded in all patients. Residual symptoms of dysphagia occurred in 67 % in the emergency group and 88% in the elective group. There was an increased incidence of heartburn compared to elective myotomy. Early operation after perforation provides good results for treatment of achalasia. Mild dysphagia persists and there is an increasing sensation of heartburn. The site of perforation is typically posterolateral, which makes laparoscopic repair difficult.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Vaezi MF, Richter JE. Current therapies for achalasia. J Clin Gastroenterol 1998;27:21–35.
Adams H, Roberts GM, Smith PM. Oesophageal tears dur- ing pneumatic balloon dilatation for the treatment of achaia- sia. Clin Radiol 1989;40:53–57.
Ferguson MK, Reeder LB, Olak J. Results of myotomy and partial fundoplication after pneumatic dilation for achalasia. Ann Thorac Surg 1996;62:327–330.
Slater G, Sicular AA. Esophageal perforations after forceful dilatation in achalasia. Ann Surg 1982;195:186–188.
Miller RE, Tiszenkel HI. Esophageal perforation due to pneu- matic dilation for achalasia. Surg Gynecol Obstet 1988;166:458–460.
Schwartz HM, Cahow CE, Traube M. Outcome after perfo- ration sustained during pneumatic dilatation for achalasia. Dig Dis Sci 1993;38:1409–1413.
Hunter JG, Trus TL, Branum GD, Waring JP. Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg 1997;225:655–665.
Anselimo M, Zaninotto G, Costantini M, Rossi M, Bocca C, Ancona E. One-year follow-up after laparoscopic Heller-Dor operation for esophageal achalasia. Surg Endosc 1997;11:3–7.
Pope CE. The quality of life following antireflux surgery. WorldJ Surg 1992;16:355–358.
Bell RC. Laparoscopic closure of esophageal perforation fol- lowing pneumatic dilatation for achalasia. Surg Endosc 1997; 11:476–478.
Nathanson LK, Gotley D, Smithers M, Branicki F. Videotho- racoscopic primary repair of early distal oesophageal perfora- tion. Aust N ZJ Surg 1993;63:399–403.
Borroto E, Gaudric M, Danel B, et al.. Risk factors of oesoph- ageal perforation during pneumatic dilatation for achalasia. Gut 1996;39:9–12.
Winans CS. Manometric asymmetry of the lower esophageal high pressure zone. AmJ Dig Dis 1977;22:348–356.
Goldstein LA, Thompson WR. Esophageal perforations. A 15 year experience. AmJ Surg 1999;143:495–502.
Pricolo VE, Park CS, Thompson WR. Surgical repair of esophageal perforation due to pneumatic dilatation for achalasia--Is myotomy really necessary? Arch Surg 1993; 128:540–544.
Rabinovici R, Katz E, Goldin E, Kluger Y, Ayalon A. The danger of high compliance balloons for esophageal dilatation in achalasia. Endoscopy 1990;22:63–64.
Wewalka FW, Clodi PH, Haidinger D. Endoscopic clipping of esophageal perforation after pneumatic dilation for achaia- sia. Endoscopy 1995;27:608–611.
Gershman G, Ament ME, Vargas J. Frequency and medical management of esophageal perforation after pneumatic di- latation in achalasia. J Pediatr Gastroenterol Nutr 1997;25:548–553.
White PG, Adams H, Smith PM. Oesophageal tears following pneumatic balloon dilatation for the treatment of achalasia [letter]. Clin Radiol 1992;46:368–369.
Swedlund A, Traube M, Siskind BN, McCalhim RW. Non- surgical management of esophageal perforation from pneu- matic dilatation in achalasia. Dig Dis Sci 1989;34:379–384.
Sauer L, Pellegrini CA, Way LW. The treatment of achalasia. Arch Surg 1989;124:929–932.
Kaiser GA, Bowman FO, Wylie RH. Definitive surgery for the treatment of esophageal perforation with distal obstruc- tion. Ann Thorac Surg 1969;8:75–81.
Raiser F, Perdekis G, Hinder RA, et al.. Heller myotomy via minimal access surgery: An evaluation of antireflux proce- dures. Arch Surg 1996; 131:593–598.
Bonavina L, Nosadini A, Bardini R, Baessato M, Peracchia A. Primary treatment of esophageal achalasia: Long term results of myotomy and Dor fundoplication. Arch Surg 1992;127:222–226.
Topart P, Deschamps C, Taillefer R, Duranceau A. Long-term effect of total fimdoplication on the myotornized esophagus. Ann Thorac Surg 1992;54:1046–1052.
Lira SK, Jorgensen JO, de Carle DJ, Hunt DR, Wallace KL, Cook IJ. Pneumatic dilatation for achalasia: Assessment of long-term symptomatic outcome [abstr]. J Gastroenterol Hepatol 1993;8:A28.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hunt, D.R., Wills, V.L., Weiss, B. et al. Management of esophageal perforation after pneumatic dilation for achalasia. J Gastrointest Surg 4, 411–415 (2000). https://doi.org/10.1016/S1091-255X(00)80021-9
Issue Date:
DOI: https://doi.org/10.1016/S1091-255X(00)80021-9