PMID- 19816021
OWN - NLM
STAT- MEDLINE
DCOM- 20100202
LR  - 20220330
IS  - 1421-9883 (Electronic)
IS  - 0253-4886 (Linking)
VI  - 26
IP  - 4
DP  - 2009
TI  - Laparoscopic Heller-Dor surgery for esophageal achalasia: impact of 
      intraoperative real-time manometric feedback on postoperative outcomes.
PG  - 342-8
LID - 10.1159/000244512 [doi]
AB  - BACKGROUND: Laparoscopic Heller myotomy with Dor fundoplication (LHD) is one of 
      the most established surgical procedures for esophageal achalasia. Preoperative 
      esophageal manometry has been reported as useful to evaluate lower esophageal 
      sphincter (LES) pressure. However, the feasibility, safety, and impact of its 
      intraoperative use have not been fully evaluated, especially when enhanced with 
      real-time 3-D pressure imaging. METHODS: LHD was attempted on 24 consecutive 
      patients with esophageal achalasia. Manometry was performed at 3 time points 
      during LHD: before myotomy, after myotomy, and after fundoplication. 
      Investigations included esophagography, manometry, and 24-hour esophageal pH 
      monitoring in the preoperative, short-term (0-5 months) and long-term (1-3 years) 
      follow-up periods. RESULTS: The 3-D intraoperative manometric images were 
      presented to the surgical crew on a monitor screen immediately after each 
      measurement in all attempted cases (n = 13). Any residual high pressure zone of 
      the LES was easily recognized and resolved with additional myotomy. Postoperative 
      esophagographies showed resolution of esophageal dilatation. Manometric 
      examination revealed significant reduction of LES pressure in the 
      short-/long-term follow-up periods. PH monitoring showed no increase in acid 
      reflux. Overall outcomes were satisfactory (symptom relief = 95%). CONCLUSION: 
      Intraoperative manometry with real-time pressure feedback is a feasible, safe, 
      and useful adjunct in LHD.
CI  - Copyright 2009 S. Karger AG, Basel.
FAU - Endo, Shunji
AU  - Endo S
AD  - Department of Surgery, Osaka University Graduate School of Medicine, Osaka 
      565-0871, Japan.
FAU - Nakajima, Kiyokazu
AU  - Nakajima K
FAU - Nishikawa, Kazuhiro
AU  - Nishikawa K
FAU - Takahashi, Tsuyoshi
AU  - Takahashi T
FAU - Souma, Yoshihito
AU  - Souma Y
FAU - Taniguchi, Eiji
AU  - Taniguchi E
FAU - Ito, Toshinori
AU  - Ito T
FAU - Nishida, Toshirou
AU  - Nishida T
LA  - eng
PT  - Journal Article
DEP - 20091006
PL  - Switzerland
TA  - Dig Surg
JT  - Digestive surgery
JID - 8501808
SB  - IM
MH  - Adult
MH  - Esophageal Achalasia/*surgery
MH  - Esophagus/diagnostic imaging/*surgery
MH  - Feasibility Studies
MH  - Female
MH  - Follow-Up Studies
MH  - Fundoplication/methods
MH  - Humans
MH  - Laparoscopy/*methods
MH  - Male
MH  - Manometry/methods
MH  - Monitoring, Intraoperative/methods
MH  - Pneumoperitoneum, Artificial
MH  - Postoperative Complications/*prevention & control
MH  - Radiography
EDAT- 2009/10/10 06:00
MHDA- 2010/02/03 06:00
CRDT- 2009/10/10 06:00
PHST- 2009/01/16 00:00 [received]
PHST- 2009/06/07 00:00 [accepted]
PHST- 2009/10/10 06:00 [entrez]
PHST- 2009/10/10 06:00 [pubmed]
PHST- 2010/02/03 06:00 [medline]
AID - 000244512 [pii]
AID - 10.1159/000244512 [doi]
PST - ppublish
SO  - Dig Surg. 2009;26(4):342-8. doi: 10.1159/000244512. Epub 2009 Oct 6.