Leakage testing at the time of surgical oesophageal myotomy

Digestive Surgery
Srdjan KosticLars Lundell

Abstract

Surgical myotomy is a well-established and validated method to treat severe gastro-oesophageal motor disorders such as achalasia. The benign character of these diseases further substantiates the importance of operating with greatest possible safety margins. We presently report our experiences with the use of perioperative leakage testing. Thirty-seven consecutive patients are reported of whom 30 had a laparoscopic, 3 a thoracoscopic and 4 an open operation. The indications for an operation were in 3 patients oesophageal spasm, in 30 patients newly diagnosed achalasia and 4 patients had an open reoperation due to a previous incomplete myotomy plus epiphrenic diverticulum. Thirty patients had a perioperative endoscopy with gas insufflation and a leakage test, whereas the others did not. A previously unrecognised oesophageal mucosal tear was discovered during the test and repaired in 4 of the 30 tested cases whereafter everyone had an uneventful postoperative recovery. Among the remaining 7 untested patients, 3 developed clinical signs of leakage of whom 1 had an immediate reoperation. The postoperative courses were in all those prolonged and complicated. Perioperative use of endoscopy at the time of completion of the surgical myo...Continue Reading

References

Nov 1, 1989·The British Journal of Surgery·R C Stuart, T P Hennessy
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Dec 14, 1999·The British Journal of Surgery·T K RantanenJ T Sipponen
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May 3, 2002·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·V L Wills, D R Hunt

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Citations

Sep 11, 2008·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Kelly R FinanMary T Hawn
Jun 23, 2000·Journal of the American Society of Nephrology : JASN·Martin BakAllan Flyvbjerg

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