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Identification of risk factors for mucosal injury during laparoscopic Heller myotomy for achalasia

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Abstract

Background

Mucosal injury during myotomy is the most frequent complication seen with the Heller–Dor procedure for achalasia. The present study aimed to examine risk factors for such mucosal injury during this procedure.

Methods

This was a retrospective analysis of patients who underwent the laparoscopic Heller–Dor procedure for achalasia at a single facility. Variables for evaluation included patient characteristics, preoperative pathophysiological findings, and surgeon’s operative experience. Logistic regression was used to identify risk factors. We also examined surgical outcomes and the degree of patient satisfaction in relation to intraoperative mucosal injury.

Results

Four hundred thirty-five patients satisfied study criteria. Intraoperative mucosal injury occurred in 67 patients (15.4 %). In univariate analysis, mucosal injury was significantly associated with the patient age ≥60 years, disease history ≥10 years, prior history of cardiac diseases, preoperative esophageal transverse diameter ≥80 mm, and surgeon’s operative experience with fewer than five cases. In multivariate analysis involving these factors, the following variables were identified as risk factors: age ≥60 years, esophageal transverse diameter ≥80 mm, and surgeon’s operative experience with fewer than five cases. The mucosal injury group had significant extension of the operative time and increased blood loss. However, there were no significant differences between the two groups in the incidence of reflux esophagitis or the degree of symptom alleviation postoperatively.

Conclusion

The fragile esophagus caused by advanced patient age and/or dilatation were risk factor for mucosal injury during laparoscopic Heller–Dor procedure. And novice surgeon was also identified as an isolated risk factor for mucosal injury.

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Disclosures

Drs. Tsuboi, Omura, Yano, Hoshino, Yamamoto, Akimoto, Masuda, Kashiwagi, and Yanaga have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Kazuto Tsuboi, Nobuo Omura, Fumiaki Yano, Masato Hoshino, Se-Ryung Yamamoto, Shusuke Akimoto, Takahiro Masuda, Hideyuki Kashiwagi & Katsuhiko Yanaga

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  1. Kazuto Tsuboi
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  2. Nobuo Omura
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  3. Fumiaki Yano
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  4. Masato Hoshino
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  5. Se-Ryung Yamamoto
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  6. Shusuke Akimoto
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  7. Takahiro Masuda
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  8. Hideyuki Kashiwagi
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  9. Katsuhiko Yanaga
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Correspondence to Kazuto Tsuboi.

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Tsuboi, K., Omura, N., Yano, F. et al. Identification of risk factors for mucosal injury during laparoscopic Heller myotomy for achalasia. Surg Endosc 30, 706–714 (2016). https://doi.org/10.1007/s00464-015-4264-0

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  • DOI: https://doi.org/10.1007/s00464-015-4264-0

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