Division of Surgical Oncology and Minimally Invasive Surgery Riverside Medical Clinic Inc. Department of Surgery/Corona Regional Medical Center, Department of Surgery/Riverside Community Hospital, Temescal Valley, California.
Oceana Gastroenterology Associates, Corona, California.
JSLS. 2022 Jul-Sep;26(3). doi: 10.4293/JSLS.2022.00027.
Laparoscopic Heller myotomy and Dor fundoplication has become the gold standard in treating esophageal achalasia and robotic surgical platform represents its natural evolution. The objective of our study was to assess durable long-term clinical outcomes in our cohort.
Between June 1, 1999 and June 30, 2019, 111 patients underwent minimally invasive treatment for achalasia (96 laparoscopically and 15 robotically). Fifty-two were males. Mean age was 49 years (20 - 96). Esophageal manometry confirmed the diagnosis. Fifty patients underwent pH monitoring study, with pathologic reflux in 18. Preoperative esophageal dilation was performed in 76 patients and 21 patients received botulin injection. Dysphagia was universally present, and mean duration was 96 months (5 - 480).
Median operative time was 144 minutes (90 - 200). One patient required conversion to open approach. Four mucosal perforations occurred in the laparoscopic group and were repaired intraoperatively. Seven patients underwent completion esophageal myotomy and added Dor fundoplication. Upper gastrointestinal series was performed before discharge. Median hospital stay was 39 hours (24 - 312). Median follow up was 157 months (6 - 240), and dysphagia was resolved in 94% of patients. Seven patients required postoperative esophageal dilation.
Minimally invasive Heller myotomy and Dor fundoplication are feasible. The operation is challenging, but excellent results hinge on the operative techniques and experience. The high dexterity, three-dimensional view, and the ergonomic movements of robotic surgery allow application of all the technical elements, achieving the best durable outcome for the patient. Robotic surgery is the natural evolution of minimally invasive treatment of esophageal achalasia.
腹腔镜 Heller 肌切开术和 Dor 胃底折叠术已成为治疗食管失弛缓症的金标准，而机器人手术平台代表了其自然演变。我们研究的目的是评估我们队列中的持久长期临床结果。
1999 年 6 月 1 日至 2019 年 6 月 30 日期间，111 例患者接受了微创治疗食管失弛缓症（96 例腹腔镜手术，15 例机器人手术）。52 例为男性。平均年龄为 49 岁（20-96 岁）。食管测压法确诊。50 例行 pH 监测研究，18 例存在病理性反流。76 例患者术前行食管扩张，21 例患者接受肉毒杆菌注射。所有患者均存在吞咽困难，平均持续时间为 96 个月（5-480 个月）。
中位手术时间为 144 分钟（90-200 分钟）。1 例患者需转为开放手术。腹腔镜组发生 4 例黏膜穿孔，术中修补。7 例患者行全食管肌切开术和附加 Dor 胃底折叠术。出院前进行上消化道造影检查。中位住院时间为 39 小时（24-312 小时）。中位随访时间为 157 个月（6-240 个月），94%的患者吞咽困难得到缓解。7 例患者术后需行食管扩张。
微创 Heller 肌切开术和 Dor 胃底折叠术是可行的。该手术具有挑战性，但良好的结果取决于手术技术和经验。机器人手术的高精度、三维视图和符合人体工程学的运动允许应用所有技术要素，为患者实现最佳的持久疗效。机器人手术是食管失弛缓症微创治疗的自然演变。
