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Mucosal Perforation During Laparoscopic Heller Myotomy Has No Influence on Final Treatment Outcome

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

The aims of the study were (a) to examine the final outcome in patients experiencing accidental mucosal perforation during laparoscopic Heller myotomy with Dor fundoplication (LHD) and (b) to evaluate whether perforation episodes might influence the way in which surgeons subsequently approached the LHD procedure.

Methods

We studied all consecutive patients that underwent LHD between 1992 and 2015. Patients were divided into two main groups: those who experienced an intraoperative mucosal perforation (group P) and those whose LHD was uneventful (group NP). Two additional groups were compared: group A, which consisted of patients operated by a given surgeon immediately before a perforation episode occurred, and group B, which included those operated immediately afterwards.

Results

Eight hundred seventy-five patients underwent LHD; a mucosal perforation was detected in 25 patients (2.9 %), which was found unrelated to patients’ symptom’s score and age, radiological stage, manometric pattern, or the surgeon’s experience. The median postoperative symptom score was similar for the two groups as the failure rate: 92 failures in group NP (10.8 %) and 4 in group P (16 %) (p = 0.34); moreover, symptoms recurred in 2 patients of group A (10 %) and 3 patients of group B (15 %) (p = 0.9).

Conclusions

Accidental perforation during LHD is infrequent and impossible to predict on the grounds of preoperative therapy or the surgeon’s personal experience. Despite a longer surgical procedure and hospital stay, the outcome of LHD is much the same as for patients undergoing uneventful myotomy. A recent mucosal perforation does not influence the surgeon’s subsequent performance.

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Acknowledgments

The authors acknowledge all other surgeons that operated in the Department of Surgery of the University of Padova during the study period: Ermanno Ancona (1992–2012), Mauro Rossi (1992–2001), Giovanni Zaninotto (1995–2007), Christian Rizzetto (2009). Without their work and dedication, this study could not have been possible.

Authors’ Contribution

Design of the work: Salvador, Costantini, Pesenti, Longo

Acquisition of data: Salvador, Pesenti, Capovilla, Voltarel, Spadotto, Capovilla, Nicoletti

Interpretation of data: Salvador, Costantini, Cavallin, Merigliano, Ruol, Valmasoni

Drafting the work: Salvador, Costantini, Pesenti, Capovilla, Voltarel, Spadotto, Nicoletti, Longo, Merigliano, Ruol, Valmasoni, Cavallin

Final approval: Salvador, Costantini, Pesenti, Capovilla, Voltarel, Spadotto, Nicoletti, Longo, Merigliano, Ruol, Valmasoni, Cavallin

Agreement to be accountable for all aspects of the work: Salvador, Costantini, Pesenti, Capovilla, Voltarel, Spadotto, Nicoletti, Longo, Merigliano, Ruol, Valmasoni, Cavallin

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Authors and Affiliations

  1. Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Padova, Italy

    Renato Salvador, Lorenzo Spadotto, Giovanni Capovilla, Guerrino Voltarel, Elisa Pesenti, Cristina Longo, Loredana Nicoletti, Alberto Ruol, Michele Valmasoni, Stefano Merigliano & Mario Costantini

  2. Surgical Oncology Unit, Veneto Institute of Oncology (IOV IRCCS), Padova, Italy

    Francesco Cavallin

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  1. Renato Salvador
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  2. Lorenzo Spadotto
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  3. Giovanni Capovilla
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  4. Guerrino Voltarel
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  5. Elisa Pesenti
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  6. Cristina Longo
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  7. Francesco Cavallin
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  8. Loredana Nicoletti
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  9. Alberto Ruol
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  12. Mario Costantini
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Correspondence to Mario Costantini.

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Salvador, R., Spadotto, L., Capovilla, G. et al. Mucosal Perforation During Laparoscopic Heller Myotomy Has No Influence on Final Treatment Outcome. J Gastrointest Surg 20, 1923–1930 (2016). https://doi.org/10.1007/s11605-016-3276-y

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  • DOI: https://doi.org/10.1007/s11605-016-3276-y

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