PMID: 9419312Jan 7, 1998Paper

Local epinephrine facilitates laparoscopic Heller myotomy

Surgical Endoscopy
G G Kuster

Abstract

Incomplete myotomy and mucosal perforation are the most common technical complications of laparoscopic esophageal myotomy. The muscle layers of the lower esophagus are infiltrated with a 1:100,000 epinephrine solution using a thin needle. Gentle pressure is applied with a peanut sponge to diminish the edema produced by the injections. The longitudinal fibers are separated with a dissector and the semicircular fibers are lifted from the submucosa with a dissector or a hook. The muscle transection is done simply by tearing the fibers or cutting them with scissors. No coagulation is required. Infiltration and topical application of epinephrine solution allowed the performance of 22 laparoscopic esophageal myotomies with excellent visualization, complete muscle division, and without any esophageal or gastric perforation. Injection and topical application of epinephrine solution to the area of the esophagus and stomach which will be subjected to myotomy greatly facilitates the procedure and helps to avoid complications.

Citations

Nov 3, 2011·Surgical Endoscopy·Dimitrios StefanidisUNKNOWN Society of American Gastrointestinal and Endoscopic Surgeons
Aug 12, 2005·Current Surgery·Gina L AdralesRichard W Schwartz
Feb 19, 1999·Journal of the American College of Surgeons·T A Bowden
Jan 13, 2000·Diseases of the Esophagus : Official Journal of the International Society for Diseases of the Esophagus·S J WalkerN Birbeck
Jan 24, 2014·Mediators of Inflammation·Amit KumarGeorges Herbein
Aug 17, 2000·The Australian and New Zealand Journal of Surgery·D R Hunt, V L Wills

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