[Peroperative diagnostic methods during esophageal achalasia surgery. Initial experience].

AIM OF THE STUDY

The authors present their first experience with the application of esophageal manometry during the operation on achalasia of esophagus. The completeness of performed myotomy is evaluated on the basis of decreased pressure in the region of lower esophageal sphincter (LES).

METHODS

Stationary pull-through four-channel manometry was performed twice during the operation: before the application of capnoperitoneum to localize LES with evaluation of its length and tonus and after the myotomy was performed after capnoperitoneum was abolished to verify sufficient extent of myotomy. The subsequent endoscopic control was used to exclude damage of esophagus mucous membrane.

RESULTS

In the period of one year during 2002/2003 the authors operated on four patients with achalasia, when manometry was used for peroperative localization of LES and evaluation of the extent of myotomy. The peroperation manometry demonstrated decreased tonus of LES (the mean 42.06 mmHg before myotomia and the mean 20.03 mmHg after myotomia) and in one case the finding resulted in necessary extension of myotomia.

CONCLUSIONS

Based on our preliminary experience with peroperation manometry in operations on achalasia of esophagus it may be stated that it is a useful method for objectivization of the completeness of myotomy, which does not significantly prolong the period of operation. It contrast, it makes it possible to respond to lasting hypertonic area in LES subjected to myotomy, which may be the cause of lasting complaints of patients after the operation.