Please use this identifier to cite or link to this item: http://hdl.handle.net/10553/135386
Title: Laparoscopic hand-sewn cardioplasty: an alternative procedure for end-stage achalasia
Authors: Senra, Fátima
Navaratne, Lalin
Acosta Mérida, María Asunción 
Gould, Stuart
Martínez-Isla, Alberto
UNESCO Clasification: 32 Ciencias médicas
3213 Cirugía
Keywords: Achalasia
Cardioplasty
Intraoperative endoscopy
Laparoscopy
Lower oesophageal sphincter
Issue Date: 2021
Journal: Langenbeck's Archives of Surgery 
Abstract: Background: 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. Methods: 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. Results: 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. Conclusion: 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.
URI: http://hdl.handle.net/10553/135386
ISSN: 1435-2443
DOI: 10.1007/s00423-021-02117-9
Source: Langenbeck's Archives of Surgery [ISSN 1435-2443], v. 406, p. 1675-1682 (marzo 2021)
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