The Role Of Intraoperative Endoscopic Guidance During Laparoscopic Repair Of Esophageal Achalasia

Purpose The aim was to assess the advantage of using intraoperative endoscopic guidance during laparoscopic repair of esophageal achalasia. Materials and methods This was a retrospective study conducted at Ain Shams Specialized Hospitals that included 84 patients. A total of 42 patients had Heller cardiomyotomy procedure with dor fundoplication and another 42 patients had the same procedure with intraoperative endoscopic guidance. Results Preoperative symptoms included dysphagia in 80 (95%) patients, regurgitation and vomiting in 60 (71.5%) patients, heartburn in 56 (66%) patients, and postprandial chest pain in 40 (49%) patients. Weight loss occurred in 42 (50%) patients. Overall, 72 (85%) patients had tried 2-3 pneumatic dilation. Mean lower esophageal sphincter pressure preoperatively was 33 and was 13.3 mmHg postoperatively (4.1-28.4). The operative time was 45 +/- 20min in the endoscopic group and was 40 +/- 10 in the nonendoscopic guidance. Overall, 5 patients of the nonendoscopic group had perforation and one case of bleeding. Postoperatively, dysphagia was seen in one (2.25%) patient of the endoscopic group and four (9.5%) patients of the nonendoscopic group. Postprandial heart pain was seen in two (4.6%) patients of the endoscopic group and four (9.2%) patients of the nonendoscopic group. Moreover, 2 (4.6%) patients of the endoscopic group and four (9.5%) patients of the nonendoscopic group had postoperative regurgitation. Weight regain was seen in 19 (90%) patients of the endoscopic group and 17 (80%) patients of the patients of nonendoscopic group after 12-month follow-up. Conclusion Heller cardiomyotomy with endoscopic guidance is very important not only as a guide to ensure adequate myotomy but also to limit the extent of the myotomy, thereby minimizing the postoperative reflux symptoms.