Cardiomyotomy dor patch

Results: Three of the 14 patients required conversion to an open procedure, and 1 underwent early laparotomy for postoperative bleeding. The median operating time was minutes range from 75 to minutes , and the median duration of hospitalization was 4 days range from 3 to 18 days. Normal physical activity was resumed after a median of 2 weeks range from 0.

Symptomatic dysphagia was completely relieved in 12 patients and improved in 2. Design A prospective case series. Setting A university teaching hospital. Patients Fourteen patients 5 men, 9 women, median age 47 years with esophageal achalasia, treated between July and July Interventions Laparoscopic Heller's cardiomyotomy with a Dor patch.

Main outcome measures Clinical relief of symptoms, confirmed by esophageal manometry, hour ambulatory pH monitoring and barium-contrast radiography. Results Three of the 14 patients required conversion to an open procedure, and 1 underwent early laparotomy for postoperative bleeding. The median operating time was minutes range from 75 to minutes , and the median duration of hospitalization was 4 days range from 3 to 18 days. Normal physical activity was resumed after a median of 2 weeks range from 0.

Symptomatic dysphagia was completely relieved in 12 patients and improved in 2. Only one patient experienced symptoms of reflux postoperatively. Postoperative esophageal manometry seven patients , hour pH monitoring five patients and barium-meal radiography seven patients confirmed the clinical results. Conclusion Laparoscopic Heller's cardiomyotomy with a Dor patch provides a viable alternative to open cardiomyotomy and forceful endoscopic dilatation.

Surveillance endoscopy at five or more years after cardiomyotomy for achalasia. Laparoscopic upper gut surgery. Defining a learning curve for laparoscopic cardiomyotomy. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Reoperation for dysphagia after cardiomyotomy for achalasia. Similar Articles To arrive at the top five similar articles we use a word-weighted algorithm to compare words from the Title and Abstract of each citation.

Laparoscopic Heller-Dor operation for patients with achalasia. Laparoscopic anterior cardiomyotomy plus anterior Dor fundoplication without division of lateral and posterior periesophageal anatomic structures for treatment of achalasia of the esophagus.

Laparoscopic cardiomyotomy and anterior partial fundoplication for achalasia. Does the addition of a fundoplication improve outcomes for patients undergoing laparoscopic Heller's cardiomyotomy? Laparoscopic management of idiopathic esophageal achalasia. Joining Europe PMC. Tools Tools overview. ORCID article claiming. Journal list. If promptly and carefully repaired at the time it is discovered, it is rarely followed by an esophageal fistula.

The most common site of the perforation is at the level of the gastroesophageal junction GEJ , and it occurs when the myotomy is extended onto the gastric wall. In addition, esophageal perforation can occur during an attempt to stop bleeding from the muscle layers by electrocautery; the monopolar current, in fact, can spread laterally causing a thermal injury of the mucosa. A perforation in this case can also occur at a later time, and is only manifested in the postoperative period.

The rate of late esophageal perforation after myotomy is not known. Open surgery: rate of esophageal perforation In Andreollo and Earlam published the results of a retrospective review of 75 papers, reporting on myotomies for achalasia [ 1 ].

In their analysis, the perforation rate was only 1. We feel that this report underestimated the real incidence of this complication. More recent reports from centers with a large experience in the treatment of achalasia have, in fact, shown a perforation rate between 2. The perforation is usually recognized and closed at the time of the operation, without late sequelae.

Minimally invasive surgery: rate of esophageal perforation Today, a Heller myotomy is performed by minimally invasive surgery thoracoscopic or laparoscopic approach , as it provides the same excellent results of open surgery but with a short hospital stay, minimal postoperative discomfort and fast return to regular activity.

This higher perforation rate is due to the limitations of the thoracoscopic or laparoscopic approach secondary to the visual equipment bidimensional view with loss of depth of field , the instrumentation, and the lack of tactile feedback.

In addition, there is clearly the effect of the learning curve of a new technique. In addition, while a perforation used to require either a laparotomy or a thoracotomy for repair, it can now easily be closed by intracorporeal suturing using minimally invasive techniques. Conclusions As surgeons gain more experience with myotomy performed by minimally invasive techniques, the rate of esophageal perforation will undoubtedly drop.

In addition, the recognition of minimally invasive surgery as the primary form of treatment for esophageal achalasia will allow surgeons to operate on a "virgin" esophagus, avoiding the anatomical changes due to previous dilatations or botulinum toxin injections which should decrease the incidence of perforation. References 1.