Pre-operative Endoscopic Treatment Does Not Adversely Impact Laparoscopic Myotomy Outcomes

S El Djouzi, MD, V B Tsirline, MD, P D Colavida, MD, A Brokamp, A Walters, MS, D Stefanidis, MD PhD, T B Heniford, MD. Carolinas Medical Center


Achalasia patients often present for laparoscopic Heller myotomy (LHM) after multiple endoscopic dilations and/or botox injections. Previously, surgeons documented concern that LHM may be substantially more difficult following these interventions due to chronic periesophageal inflammation. We compared outcomes of LHM based on preoperative endoscopic procedures in order to determine risk of operative therapy.

A review of 166 consecutive LHM cases from December 1998 to September 2011 at a tertiary care hospital was performed. Included were patients’ history of endoscopic intervention(s) ,OR time, estimated blood loss (EBL), intra and post-op complications, and LOS as surrogate markers.

Average age was 45.7 ± 1.3 and 51% were male. Mean BMI was 26.0 ± 0.82. In toto, 3.8% had prior myotomies. Of 166 patients, 27% had preoperative botox injection, 40% had at least one dilatation and 10.8% had both. The demographics and comorbidities were similar between groups. Median surgery duration was 180 min, EBL was 39 cc, and LOS was 2 days. There was no statistical differences between patients who had preoperative botox injection and those who did not in terms of surgery duration (185.37 min ± 9.93 vs 186.87 min ±4.68, p = 0.220), EBL (50.0 ml ± 10.36 vs 95.21 ml ± 20.48 , p = 0.103) or LOS (2.34 days ± 0.276 vs 2.45min ± 0.326 , p = 0.160). Likewise, there were no significant differences between patients who had and had not had preoperative dilation. Incidence of pre-operative and post-operative complications between the endoscopic intervention groups and those without were 6.7% vs. 3.4%, and not significantly different (p=0.347). No patient suffered an esophageal perforation.

The peri-operative course of the Heller myotomy patients is not influenced by pre-operative endoscopic treatments with therapeutic intent. The length of operation and incidence of complications were not altered. Pre-operative endoscopic Botox and/or dilation, even several of them in a single patient, does not predispose a patient to greater risk of perforation.

Session Number: ResFel – Residents/Fellows Scientific Session
Program Number: S133

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