Factors Affecting Perioperative Morbidity after Laparoscopic Esophageal Myotomy for Achalasia
Abstracts
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Objectives: We analyzed factors affecting perioperative morbidity after laparoscopic esophageal myotomy (LEM) for achalasia. Methods: From January 1996 to April 2001, 112 patients (pts) with achalasia (57 males and 55 females) were treated with LEM. Median age was 47 years (range, 13-85 years). Sixty-three pts (56.3%) had previous esophageal dilatation and/or Botox injection and 6 (5.4%) had a previous myotomy. A robotic arm was used to manipulate the camera in 79 pts (71.0%). A distal esophageal myotomy extended on to the stomach for 1.5 cm was performed in all 112 pts. A partial fundoplication was performed in 103 pts (92.0%); posterior in 76 and anterior in 27. Results: Intraoperative complications occurred in 25 pts (22.3%) and included intraoperative mucosal laceration in 22, and pneumothorax, splenic capsular tear, and short gastric bleeding in one each. Four pts (3.6%) were converted to an open procedure. Median hospitalization was 2 days (range, 1-48 days). Postoperative complications occurred in 13 pts (11.6%). There were no operative deaths. Follow-up was complete in 91 pts (81.2%) and ranged from 5 to 41 months (median, 8 months). Functional results were classified as excellent in 66 pts (72.5%), good in 18 (19.8%), fair in 4 (4.4%) and poor in 3 (3.3%). Advanced age and preoperative endoscopic treatment (dilatations and/or Botox) were associated with increased intraoperative complications (p<0.05). Conclusions: We conclude that laparoscopic esophageal myotomy for achalasia results in symptomatic relief in the majority of patients. Increased intraoperative morbidity was associated with advanced age and preoperative endoscopic treatment. |
