Publications of Faculty of Medicine:Endoscopic-guided Laparoscopic Myotomy For Esophageal Achalasia: Abstract

Endoscopic-guided Laparoscopic Myotomy For Esophageal Achalasia
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This study was designed to evaluate the success rate of stepwise endoscopically-guided laparoscopic Heller myotomy (LHM) for management of achalasia of the cardia in comparison to LHM without endoscopic guidance and comprised 18 patients allocated in 2 equal (n=9) groups: Group A included patients assigned to undergo endoscopically-guided LHM and Group B included patients underwent surgery without endoscopic guidance. After full history taking, complete physical examination, routine laboratory and radiological examinations and upper gastrointestinal endoscopy and motility studies, patients underwent LHM that in group A, encompassed intraoperative illumination of the esophageal lumen using endoscopy to facilitate identification and piecemeal dissection of the esophagus. Intraoperative morbidity, duration of surgery, postoperative hospital stay and occurrence of postoperative complications were reported. No case required shift to open procedure and no perforation had occurred in group A, whereas 2 cases of small perforation occurred in group B. There was a significant reduction of the operative time (559 vs. 64.49.5 min) and postoperative hospital stay (3.21 vs. 4.81.4 days) in group A compared to group B. There were 3 cases with mild reflux symptoms; two in group B and one in group A, both cases responded to medical treatment and one case in group B with persistent symptoms required endoscopic balloon dilation with a significant reduction in frequency ofintra- and postoperative complications in favor of group A. It could be concluded that LHM is a safe and effective minimally invasive procedure for treatment of achalasia of the cardia with more favorable outcome and short operative time and hospital stay when performed endoscopically-guided