Laparoscopic heller’s cardiomyotomy

Aim : The aim of this study was to investigate whether intraoperative endoscopy (IOE) helps to identify the gastroesophageal junction, thereby reducing the frequency of suboptimal distal myotomy extent during laparoscopic Heller’s cardiomyotomy. To this end, laparoscopic and endoscopic criteria for localization of the cardia were compared. Then surgical outcomes in two consecutive groups of patients treated without and with IOE were assessedInappropriate length of the myotomy incision along the stomach, the most common technical fault during Heller’s cardiomyotomy, is related to the difficulty of identifying the gastro-esophageal junction, in particular during laparoscopic surgery. The goal of this study was to evaluate the contribution of endoscopy to gastro-esophageal junction identification during laparoscopic Heller’s cardiomyotomy. Methods: From the literature a group of patients with intraoperative endoscopy with laparoscopic Heller’s cardiomyotomy, surgical and endoscopic criteria for gastro-esophageal junction identification have been assessed. Then postoperative results of this group were compared with those of another group of patients previously operated on without intraoperative endoscopy. Results: Endoscopic and laparoscopic criteria for gastroesophageal junction identification were discordant in the patients The cardia was in all these cases at a more distal site with endoscopic criteria. Complications ascribable to suboptimal technique were more frequent in the group without intraoperative endoscopy than in the other group. Conclusions: Endoscopy during laparoscopic Heller’s cardiomyotomy is of great assistance in identifying the cardia, and thereby could improve surgical outcomes. Most failures and postoperative complications seen with Heller’s procedure are due to technical faults, of which the most common is inappropriate length of the gastric end of the myotomy due to the difficulty of identifying the gastroesophageal junction . A short myotomy is associated with an increased risk of persistent or recurrent dysphagia, and a long myotomy with an increased risk of gastroesophageal reflux.