Endoscopy 2001; 33(11): 961-965
DOI: 10.1055/s-2001-17916
DDW Reports 2001
© Georg Thieme Verlag Stuttgart · New York

Laparoscopy and Related Topics

M. B. Mortensen
  • Dept. of Surgical Gastroenterology, Odense University Hospital, Odense, Denmark
Further Information

Publication History

Publication Date:
18 October 2001 (online)

Laparoscopic Cardiomyotomy

Laparoscopic cardiomyotomy (LCM) is now considered to be the preferred treatment for achalasia. However, there is still controversy regarding whether or not to perform an antireflux procedure, and if so what kind of antireflux operation should be done. The need for intraoperative flexible endoscopy has also been questioned. One hundred patients who underwent LCM were prospectively evaluated regarding dysphagia, reflux symptoms, and overall outcome [1]. Fundoplication was performed in 21 patients due to large hiatus hernias, or as part of repair of esophageal perforation. The number of perforations was not stated. The remaining 79 patients had LCM without concomitant fundoplication. The overall improvement was the same in the two groups, and the preoperative and postoperative dysphagia, reflux scores, and dysphagia scores were similar for the two groups. Based on these results, the authors concluded that intraoperative endoscopy helps avoid disruption of natural antireflux mechanisms, as well as excessive myotomy during LCM.

Although they used different end points and follow-up periods, two large single-center studies reported excellent results after LCM, including anterior Dor [2] or posterior Toupet fundoplication [3]. A univariate logistic regression used to analyze the relationship between clinical factors and patient outcome in 38 cases demonstrated that patients with a long duration of symptoms, a tortuous esophagus, and intraoperative perforation were less likely to have a good outcome. Preoperative weight loss and hemifundoplication were significant predictors of good outcome [4]. From a prospective database of over 1000 patients, 21 patients aged 63 or older were analyzed with regard to the American Society of Anesthesiologists (ASA) score, duration of surgery, length of hospital stay, perioperative complications, and operative mortality. In comparison with the results of LCM in a significantly younger population (n = 33), there were no significant differences in the duration of surgery, length of hospital stay, complications, or mortality after surgery [5]. In general, the reported results after LCM, with or without concomitant fundoplication, are good. However, comparisons between studies are difficult due to different end point evaluations and follow-up periods.

References

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M. B. Mortensen, M.D., Ph.D.

Dept. of Surgical Gastroenterology
Odense University Hospital

5000 Odense C
Denmark


Fax: + 45-65-91-98-72

Email: m.bau@dadlnet.dk

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