General Surgery Department, London North West University Healthcare NHS Trust, Watford Road, Harrow, HA1 3UJ, UK.
General Surgery Department, Hospital Universitario de Gran Canaria Doctor Negrín, Plaza Barranco de La Ballena, s/n, 35010, Las Palmas de Gran Canaria, Las Palmas, Spain.
Langenbecks Arch Surg. 2021 Aug;406(5):1675-1682. doi: 10.1007/s00423-021-02117-9. Epub 2021 Mar 24.
Primary achalasia is a rare oesophageal motor disorder characterized by the absence of swallow-induced relaxation of the lower oesophageal sphincter and diminished or absent oesophageal body peristalsis. Around 5% of these patients will develop end-stage achalasia, where oesophagectomy may be advocated. We present the laparoscopic hand-sewn cardioplasty as an alternative 'oesophagus-preserving' procedure in patients with end-stage achalasia.
We present a retrospective review of four patients who underwent laparoscopic hand-sewn cardioplasty. Data collected included pre-operative demographic information and investigations; and post-operative outcomes. Patients were scored pre- and post-operatively using Reflux Symptom Index, Eating Assessment Tool-10 and Voice Handicap Index-10 questionnaires.
Four patients underwent laparoscopic hand-sewn cardioplasty during the study period. In one patient, it was performed as a rescue procedure during attempted myotomy following multiple perforations of friable mucosa. In the other three patients, laparoscopic hand-sewn cardioplasty was performed for end-stage achalasia. None of the patients had post-operative complications and all patients were discharged on the second post-operative day. All patients experienced improvement in swallowing symptoms (EAT-10; p = 0.03) but developed post-operative gastroesophageal reflux.
To our knowledge, this is the first published case series of laparoscopic hand-sewn cardioplasty for end-stage achalasia. It appears to be a safe and effective procedure for the treatment of end-stage achalasia, offering an alternative minimally invasive procedure to oesophagectomy. Laparoscopic hand-sewn cardioplasty can also be used as a 'rescue' procedure during myotomy in patients who have poor-quality mucosa which perforates intra-operatively or is at high risk of perforation/leaking post-operatively.
原发性贲门失弛缓症是一种罕见的食管运动障碍，其特征为吞咽时食管下括约肌不松弛，食管体蠕动减弱或消失。这些患者中约有 5%会发展为贲门失弛缓症终末期，可能需要进行食管切除术。我们介绍了腹腔镜手工贲门成形术，作为贲门失弛缓症终末期患者的一种替代“保留食管”的手术方法。
我们回顾性分析了 4 例行腹腔镜手工贲门成形术的患者。收集的数据包括术前人口统计学信息和检查结果；以及术后结果。患者在术前和术后使用反流症状指数、进食评估工具-10 和嗓音障碍指数-10 问卷进行评分。
在研究期间，有 4 名患者接受了腹腔镜手工贲门成形术。其中 1 例患者在多次脆弱黏膜穿孔后试图进行肌切开术时，该手术作为挽救性手术。另外 3 例患者因贲门失弛缓症终末期而行腹腔镜手工贲门成形术。所有患者均无术后并发症，均于术后第 2 天出院。所有患者吞咽症状均有改善（EAT-10；p=0.03），但均出现术后胃食管反流。
据我们所知，这是首例关于腹腔镜手工贲门成形术治疗贲门失弛缓症终末期的病例系列研究。对于治疗贲门失弛缓症终末期，该手术似乎是一种安全有效的方法，为食管切除术提供了一种替代的微创方法。在术中黏膜质量差、术中穿孔或术后穿孔/漏风险高的患者进行肌切开术时，腹腔镜手工贲门成形术也可用作“挽救”手术。
