Abstract
Background: We describe the findings on esophagography, the frequency and appearance of leaks after laparoscopic Heller myotomy and fundoplication, and the utility of early postoperative studies for predicting clinical outcome.
Methods: Our study group consisted of 40 patients who underwent laparoscopic Heller myotomy and fundoplication in whom radiographic studies were performed during the early postoperative period. The radiographic reports and images were reviewed to determine the esophageal diameter, visualization or nonvisualization of the wrap, and the presence or absence of a leak. The esophageal diameter subsequently was correlated with the clinical findings to determine whether this was a useful parameter for predicting clinical outcome.
Results: Two patients (5%) had small, sealed-off leaks on radiographic studies, and four (10%) had pseudo-leaks resulting from trapping of contrast material alongside the fundoplication wrap. Twelve (60%) of 20 patients with a dilated esophagus had esophageal symptoms on short-term follow-up versus three (15%) of 20 with a normal-caliber esophagus (p = 0.008), and five (56%) of nine patients with a dilated esophagus had symptoms on long-term follow-up versus six (43%) of 14 with a normal-caliber esophagus (p = 0.68).
Conclusion: Radiographic studies are useful for showing leaks after laparoscopic Heller myotomy and fundoplication, but radiologists should differentiate true leaks from trapping of contrast material alongside the fundoplication wrap. The caliber of the esophagus on early postoperative studies is also a useful parameter for predicting short-term clinical outcome in these patients.
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References
MG Patti CA Pellegrini M Arcerito et al. (1995) ArticleTitleComparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders Arch Surg 130 609–615 Occurrence Handle1:STN:280:ByqB1czksV0%3D Occurrence Handle7763169
D Vogt M Curet D Pitcher et al. (1997) ArticleTitleSuccessful treatment of esophageal achalasia with laparoscopic Heller myotomy and Toupet fundoplication Am J Surg 174 709–714 Occurrence Handle10.1016/S0002-9610(97)00197-9 Occurrence Handle1:STN:280:DyaK1c%2Fnt1alsg%3D%3D Occurrence Handle9409602
M Anselmino G Perdikis RA Hinder et al. (1997) ArticleTitleHeller myotomy is superior to dilatation for the treatment of early achalasia Arch Surg 132 233–240 Occurrence Handle1:STN:280:ByiB3sngtlU%3D Occurrence Handle9125019
R Rosati U Fumagalli S Bona et al. (1998) ArticleTitleEvaluating results of laparoscopic surgery for esophageal achalasia Surg Endosc 12 270–273 Occurrence Handle10.1007/s004649900649 Occurrence Handle1:STN:280:DyaK1c7mvFGrsg%3D%3D Occurrence Handle9502710
MG Patti CA Pellegrini S Horgan et al. (1999) ArticleTitleMinimally invasive surgery for achalasia Ann Surg 230 587–594 Occurrence Handle10.1097/00000658-199910000-00014 Occurrence Handle1:STN:280:DyaK1MvltVGlsQ%3D%3D Occurrence Handle10522728
DT Dempsey MMH Kalan RS Gerson et al. (1999) ArticleTitleComparison of outcomes following open and laparoscopic esophagomyotomy for achalasia Surg Endosc 13 747–750 Occurrence Handle10.1007/s004649901091 Occurrence Handle1:STN:280:DyaK1MzlvF2jtg%3D%3D Occurrence Handle10430677
G Zaninotto M Costantini D Molena et al. (2000) ArticleTitleTreatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients J Gastrointest Surg 4 282–289 Occurrence Handle10.1016/S1091-255X(00)80077-3 Occurrence Handle1:STN:280:DC%2BD3czosFyjtQ%3D%3D Occurrence Handle10769091
M Katilius V Velanovich (2001) ArticleTitleHeller myotomy for achalasia: quality of life comparison of laparoscopic and open approaches J Soc Laparoendosc Surg 5 227–231 Occurrence Handle1:STN:280:DC%2BD3MvpvFOisA%3D%3D
AF Fernandez MA Martinez J Ruiz et al. (2003) ArticleTitleSix years of experience in laparoscopic surgery of esophageal achalasia Surg Endosc 17 153–156 Occurrence Handle10.1007/s00464-002-8576-5 Occurrence Handle1:STN:280:DC%2BD3s%2FmtFKnsw%3D%3D Occurrence Handle12399873
G Pechlivanides E Chrysos E Athanasakis et al. (2001) ArticleTitleLaparoscopic Heller cardiomyotomy and Dor fundoplication for esophageal achalasia: possible factors predicting outcome Arch Surg 136 1240–1243 Occurrence Handle10.1001/archsurg.136.11.1240 Occurrence Handle1:STN:280:DC%2BD38%2FivVGqtg%3D%3D Occurrence Handle11695966
MG Patti PM Fisichella S Perretta et al. (2003) ArticleTitleImpact of minimally invasive surgery on treatment of esophageal achalasia: a decade of change J Am Coll Surg 196 698–705 Occurrence Handle10.1016/S1072-7515(02)01837-9 Occurrence Handle12742198
JG Hunter TL Trus GD Branum JP Waring (1997) ArticleTitleLaparoscopic Heller myotomy and fundoplication for achalasia Ann Surg 225 655–665 Occurrence Handle10.1097/00000658-199706000-00003 Occurrence Handle1:STN:280:ByiA2svjsFM%3D Occurrence Handle9230806
L Bonavina R Incarbone M Reitano et al. (2000) ArticleTitleDoes previous endoscopic treatment affect the outcome of laparoscopic Heller myotomy Ann Chir 125 45–49 Occurrence Handle10.1016/S0003-3944(00)00289-3 Occurrence Handle1:STN:280:DC%2BD3cvpvFWltg%3D%3D Occurrence Handle10921184
M Bloomston W Boyce J Mamel et al. (2000) ArticleTitleVideoscopic Heller myotomy for achalasia: results beyond short-term follow-up J Surg Res 92 150–156 Occurrence Handle10.1006/jsre.2000.5886 Occurrence Handle1:STN:280:DC%2BD3czpslOqtg%3D%3D Occurrence Handle10896815
MG Patti CV Feo U Diener et al. (1999) ArticleTitleLaparoscopic Heller myotomy relieves dysphagia in achalasia when the esophagus is dilated Surg Endosc 13 843–847 Occurrence Handle10.1007/s004649901117 Occurrence Handle1:STN:280:DyaK1MzotVKnug%3D%3D Occurrence Handle10449836
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Yoo, C., Levine, M., Redfern, R. et al. Laparoscopic Heller myotomy and fundoplication: findings and predictive value of early postoperative radiographic studies. Abdom Imaging 29, 643–647 (2004). https://doi.org/10.1007/s00261-004-0182-7
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DOI: https://doi.org/10.1007/s00261-004-0182-7