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Intraoperative Esophagogastroduodenoscopy During Heller Myotomy: Evaluating Guidelines

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Abstract

Background

National guidelines suggest routine intraoperative esophagogastroduodenoscopy (EGD) during laparoscopic Heller myotomy (LHM) to assess for mucosal perforation and myotomy adequacy, but the utility of this is unknown. This study aimed to evaluate the effect of intraoperative EGD on outcomes after LHM.

Methods

Patients who underwent LHM in a single center were retrospectively identified. Outcomes were compared between patients who did and did not undergo intraoperative EGD.

Results

Sixty-one patients were reviewed: 46 (75%) underwent intraoperative EGD and 15 (25%) did not. Mucosal perforations occurred in 2 (4%) of the EGD group and 3 (20%) of the non-EGD group (p = 0.06). All perforations, regardless of EGD use, were recognized laparoscopically. There were no postoperative leaks. Failed myotomy occurred in 5 (11%) who underwent EGD and 1 (7%) who did not (p = 0.64).

Conclusions

Because EGD does not appear to improve outcomes after LHM, we emphasize its selective, rather than routine, use.

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References:

  1. Pandolfino JE, Kahrilas PJ (2013) Presentation, diagnosis, and management of achalasia. Clin Gastroenterol Hepatol 11:887–897

    Article  Google Scholar 

  2. Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57

    Article  Google Scholar 

  3. Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, FanelliSociety of American RDG, Endoscopic S (2012) SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc 26:296–311

    Article  Google Scholar 

  4. Ross SW, Oommen B, Wormer BA, Walters AL, Matthews BD, Heniford BT, Augenstein VA (2015) National outcomes of laparoscopic Heller myotomy: operative complications and risk factors for adverse events. Surg Endosc 29:3097–3105

    Article  Google Scholar 

  5. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111:518–526

    CAS  PubMed  Google Scholar 

  6. Rosati R, Fumagalli U, Bonavina L, Segalin A, Montorsi M, Bona S, Peracchia A (1995) Laparoscopic approach to esophageal achalasia. Am J Surg 169:424–427

    Article  CAS  Google Scholar 

  7. Vaziri K, Soper NJ (2008) Laparoscopic Heller myotomy: technical aspects and operative pitfalls. J Gastrointest Surg 12:1586–1591

    Article  Google Scholar 

  8. Litle VR (2008) Laparoscopic Heller myotomy for achalasia: a review of the controversies. Ann Thorac Surg 85:S743-746

    Article  Google Scholar 

  9. Pontone S, Urciuoli P, Pontone P, Custureri F (2011) Dor against toupet fundoplication after heller myotomy: laparoscopic technical improvements and endoscopic support. J Gastrointest Surg 15:2119–2120

    Article  Google Scholar 

  10. Chapman JR, Joehl RJ, Murayama KM, Tatum RP, Shi G, Hirano I, Jones MP, Pandolfino JE, Kahrilas PJ (2004) Achalasia treatment: improved outcome of laparoscopic myotomy with operative manometry. Arch Surg 139:508–513

    Article  Google Scholar 

  11. Jafri M, Alonso M, Kaul A, Dierig J, Racadio J, Inge T, Brown R, Ryckman F, Tiao G (2008) Intraoperative manometry during laparoscopic Heller myotomy improves outcome in pediatric achalasia. J Pediatr Surg 43:66–70

    Article  Google Scholar 

  12. Mattioli S, Ruffato A, Lugaresi M, Pilotti V, Aramini B, D’Ovidio F (2010) Long-term results of the Heller-Dor operation with intraoperative manometry for the treatment of esophageal achalasia. J Thorac Cardiovasc Surg 140:962–969

    Article  Google Scholar 

  13. Pandolfino JE, de Ruigh A, Nicodeme F, Xiao Y, Boris L, Kahrilas PJ (2013) Distensibility of the esophagogastric junction assessed with the functional lumen imaging probe (FLIP) in achalasia patients. Neurogastroenterol Motil 25:496–501

    Article  CAS  Google Scholar 

  14. Ilczyszyn A, Hamaoui K, Cartwright J, Botha A (2016) Intraoperative distensibility measurement during laparoscopic Heller’s myotomy for achalasia may reduce the myotomy length without compromising patient outcome. Dis Esophagus 29:455–462

    Article  CAS  Google Scholar 

  15. Finan KR, Renton D, Vick CC, Hawn MT (2009) Prevention of post-operative leak following laparoscopic Heller myotomy. J Gastrointest Surg 13:200–205

    Article  Google Scholar 

  16. Zhang LP, Chang R, Matthews BD, Awad M, Meyers B, Eagon JC, Brunt LM (2014) Incidence, mechanisms, and outcomes of esophageal and gastric perforation during laparoscopic foregut surgery: a retrospective review of 1,223 foregut cases. Surg Endosc 28:85–90

    Article  Google Scholar 

  17. Schlottmann F, Strassle PD, Patti MG (2018) Association of surgical volume with perioperative outcomes for esophagomyotomy for esophageal achalasia. JAMA Surg 153:383–386

    Article  Google Scholar 

  18. Bello B, Herbella FA, Patti MG (2011) Evolution of the minimally invasive treatment of esophageal achalasia. World J Surg 35:1442–1446

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, University of Louisville, 550 S. Jackson St, 2nd floor, Louisville, KY, 40202, United States of America

    Elizabeth H. Bruenderman, Neal Bhutiani, Stacy B. Block & Farid J. Kehdy

  2. Department of Surgery, Division of Surgical Oncology, University of Louisville, Louisville, KY, United States of America

    Robert C. G. Martin

  3. Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, KY, United States of America

    Matthew P. Fox & Victor H. van Berkel

Authors
  1. Elizabeth H. Bruenderman
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  2. Neal Bhutiani
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  3. Robert C. G. Martin
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  4. Matthew P. Fox
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  5. Victor H. van Berkel
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  6. Stacy B. Block
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  7. Farid J. Kehdy
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Correspondence to Farid J. Kehdy.

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Bruenderman, E.H., Bhutiani, N., Martin, R.C.G. et al. Intraoperative Esophagogastroduodenoscopy During Heller Myotomy: Evaluating Guidelines. World J Surg 45, 808–814 (2021). https://doi.org/10.1007/s00268-020-05870-y

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  • DOI: https://doi.org/10.1007/s00268-020-05870-y

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