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J Laparoendosc Adv Surg Tech A. 2006 Dec;16(6):587-92.

Distal esophageal perforation repair during laparoscopic esophagomyotomy: evaluation of outcomes and review of surgical technique.

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  • 1Endoscopic Surgery Division, Hospital General Dr. Manuel Gea Gonz├ílez, Mexico City, Mexico. pfreddy@telcel.net.ve

Abstract

OBJECTIVE:

To describe the technique employed and our experience with primary laparoscopic repair of distal esophageal perforations produced during laparoscopic esophagomyotomy, as well as to evaluate the outcomes.

MATERIALS AND METHODS:

We analyzed six cases of patients with primary achalasia in whom distal esophageal mucosal perforations were caused during laparoscopic esophagomyotomy. A primary repair and fundoplication was performed in five cases; in the sixth patient, the perforation could not be recognized during the surgical procedure. The postoperative follow-up included clinical evaluation, upper gastrointestinal endoscopy, esophageal manometry, and ambulatory 24-h esophageal pH monitoring.

RESULTS:

Five patients reported dysphagia relief and were highly satisfied with the final surgical outcome. In one case we observed an altered postoperative 24-h esophageal pH. Two patients developed esophageal leakage, one with a fatal outcome.

CONCLUSION:

The primary repair of distal esophageal perforations during laparoscopic esophagomyotomy is a valid therapeutic option and does not alter the surgical purpose. However, if the perforation is not recognized early on, the prognosis can change.

PMID:
17243875
[PubMed - indexed for MEDLINE]
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