Laparoscopy and Related Topics

Laparoscopic Cardiomyotomy

Laparoscopic cardiomyotomy (LCM) is now considered to be the preferred treatment for achalasia. However, there is still controversy regarding whether or not to perform an antireflux procedure, and if so what kind of antireflux operation should be done. The need for intraoperative flexible endoscopy has also been questioned. One hundred patients who underwent LCM were prospectively evaluated regarding dysphagia, reflux symptoms, and overall outcome [1]. Fundoplication was performed in 21 patients due to large hiatus hernias, or as part of repair of esophageal perforation. The number of perforations was not stated. The remaining 79 patients had LCM without concomitant fundoplication. The overall improvement was the same in the two groups, and the preoperative and postoperative dysphagia, reflux scores, and dysphagia scores were similar for the two groups. Based on these results, the authors concluded that intraoperative endoscopy helps avoid disruption of natural antireflux mechanisms, as well as excessive myotomy during LCM.

Although they used different end points and follow-up periods, two large single-center studies reported excellent results after LCM, including anterior Dor [2] or posterior Toupet fundoplication [3]. A univariate logistic regression used to analyze the relationship between clinical factors and patient outcome in 38 cases demonstrated that patients with a long duration of symptoms, a tortuous esophagus, and intraoperative perforation were less likely to have a good outcome. Preoperative weight loss and hemifundoplication were significant predictors of good outcome [4]. From a prospective database of over 1000 patients, 21 patients aged 63 or older were analyzed with regard to the American Society of Anesthesiologists (ASA) score, duration of surgery, length of hospital stay, perioperative complications, and operative mortality. In comparison with the results of LCM in a significantly younger population (n = 33), there were no significant differences in the duration of surgery, length of hospital stay, complications, or mortality after surgery [5]. In general, the reported results after LCM, with or without concomitant fundoplication, are good. However, comparisons between studies are difficult due to different end point evaluations and follow-up periods.

References

• 1 Blommston M, Serafini F. Routine fundoplication is not necessary with laparoscopic Heller myotomy and intraoperative endoscopy [abstract].  Gastroenterology. 2001;  120 A476
• 2 Daniels L J, O’Halloran E K, Onaitis M W, Eubanks S Jr. Laparoscopic Heller myotomy as an effective and durable treatment for achalasia: the Duke University experience [abstract].  Gastroenterology. 2001;  120 A479
• 3 Glasgow R E, Khajanchee Y S, Urbach D R, et al. A comparison between subjective outcomes of laparoscopic Heller myotomy and Toupet fundoplication for achalasia [abstract].  Gastroenterology. 2001;  120 A478
• 4 Bradley K M, Migaly J, Dempsey D T, et al. Minimally invasive esophagomyotomy for achalasia: predictors of outcome [abstract].  Gastroenterology. 2001;  120 A479
• 5 McNatt S S, Smith C D, Hunter J G, Galloway K D. Primary motor disorders of the esophagus in the aged: should laparoscopic Heller myotomy be withheld? [abstract].  Gastroenterology. 2001;  120 A479
• 6 Swanstrom L L, Khajanchee Y S, Lockhart B. Treatment and natural history of patients referred for antireflux surgery with normal preoperative 24 hr pH test results [abstract].  Gastroenterology. 2001;  120 A478
• 7 Klingensmith M E, Dunnegan D L, Frisella P, et al. Clinical outcome of laparoscopic antireflux surgery (LARS) in patients eligible for endoluminal therapies [abstract].  Gastroenterology. 2001;  120 A477
• 8 Granderath F A, Schweiger U M, Kamolz T, et al. Laparoscopic antireflux surgery with routine hiatoplasty in the treatment of gastroesophageal reflux disease [abstract].  Gastroenterology. 2001;  120 A480
• 9 Kiviluoto T A, Siren J, Farkkila M, et al. Laparoscopic floppy Nissen vs. Toupet partial fundoplication: a prospective randomized study [abstract].  Gastroenterology. 2001;  120 A476
• 10 Granderath F A, Kamolz T, Scweiger U M, et al. Quality of life, surgical outcome and patient’s satisfaction three years after laparoscopic antireflux surgery [abstract].  Gastroenterology. 2001;  120 A477
• 11 Anvari M, Allen C J. Five year comprehensive follow-up on 181 patients after laparoscopic Nissen fundoplication [abstract].  Gastroenterology. 2001;  120 A435
• 12 Gibbons T E, Ricketts R R, Wulkan M, Gold B D. Nissen fundoplication: open versus laparoscopic technique in children population less than 5 years old [abstract].  Gastroenterology. 2001;  120 A435
• 13 Mattar S G, Bowers S P, Bradshaw W A, et al. Laparoscopic repair of paraesophageal hernia is subject to recurrence but rarely requires reoperation [abstract].  Gastroenterology. 2001;  120 A478
• 14 Hamad G G, Fernando H C, Ikramuddin S, et al. Paraesophageal hernia in young adults [abstract].  Gastroenterology. 2001;  120 A480
• 15 Quinn T M, Gagner M, de Csepel J, et al. Laparoscopic Roux-en-Y gastric by-pass is more effective than laparoscopic gastric banding for weight loss [abstract].  Gastroenterology. 2001;  120 A487
• 16 Nguyen N T, Fleming N, Yahr J, et al. Respiratory mechanics during laparoscopic and open gastric bypass [abstract].  Gastroenterology. 2001;  120 A490
• 17 Davila-Cervantes A O, Borunda D, Dominguez G, et al. Open versus laparoscopic vertical banded gastroplasty: a randomized double blind controlled trial [abstract].  Gastroenterology. 2001;  120 A490
• 18 Schneider A R, Arnold J C, Adamek H E, et al. Magnetic resonance imaging and diagnostic laparoscopy for the staging of pancreatic carcinoma [abstract].  Gastrointest Endosc. 2001;  53 AB132
• 19 Tsioulias G J, Wood T F, Chung M H, et al. Diagnostic laparoscopy and laparoscopic ultrasonography are essential for staging intraabdominal neoplasms [abstract].  Gastroenterology. 2001;  120 A482
• 20 Levy P, Trivin F, Sauvanet A, et al. Does laparoscopy still improve the accuracy of preoperative resectability staging of pancreatic head carcinoma (PHA) at the era of spiral CT (sCT) and endoscopic ultrasonography (EUS)? [abstract].  Gastroenterology. 2001;  120 A761
• 21 Skelly R T, Taylor M A, Clements B WD, Regan M C. Laparoscopy in the staging of upper gastrointestinal malignancy [abstract].  Gastroenterology. 2001;  120 A490
• 22 Brooks A D, Mallis M, Brennan M F, Conlon K C. The value of laparoscopy in the management of non-pancreatic periampullary tumors [abstract].  Gastroenterology. 2001;  120 A106
• 23 Walsh R M, Heniford B T, Brody F. Endoscopically-guided, laparoscopic intragastric resection of gastric stromal tumors [abstract].  Gastroenterology. 2001;  120 A489
• 24 Hamad G G, Ikramuddin S, Posner M G, et al. Minimally invasive resection of gastric stromal tumors [abstract].  Gastroenterology. 2001;  120 A491
• 25 Otani Y, Furukawa T, Kubota T, et al. Feasibility of laparoscopic wedge resection for gastric stromal tumors [abstract].  Gastroenterology. 2001;  120 A490
• 26 Almeida J A, Franklin M E, Glass J, Michaelson R L. Laparoscopic treatment of chronic and acute bowel obstruction: a valid alternative [abstract].  Gastroenterology. 2001;  120 A486
• 27 Partridge S K, Hodin R A. Laparoscopically-assisted intestinal surgery using the Pfannenstiel incision [abstract].  Gastroenterology. 2001;  120 A487
• 28 Lacy A M, Delgado S, Castells A, et al. Laparoscopic assisted colectomy (LAC) for colon cancer: results of a randomized controlled trial [abstract].  Gastroenterology. 2001;  120 A35
• 29 Almeida J A, Franklin M E, Abrego D, et al. Laparoscopic resection for colorectal cancer: long term results from a single institution [abstract].  Gastroenterology. 2001;  120 A473
• 30 Liu S I, Hodin R A. Factors associated with conversion to laparotomy in patients undergoing laparoscopic appendectomy [abstract].  Gastroenterology. 2001;  120 A476
• 31 Young-Fadok T M, Pemberton J H, Camilleri M. A case-controlled study of laparoscopic total abdominal colectomy and ileorectal anastomosis (TAC-IRA) with open TAC-IRA for slow transit constipation (STC) [abstract].  Gastroenterology. 2001;  120 A476
• 32 Mergener K, Gerke H, Kiesslich R, et al. Mini-laparoscopy assisted PEG/PEJ-placement: a new method to facilitate percutaneous endoscopic insertion of feeding tubes in “difficult” patients [abstract].  Gastrointest Endosc. 2001;  53 AB128
• 33 Lewis B S, de Lillo A R, Legnani P E, et al. Primary exploratory laparoscopy in younger patients with obscure gastrointestinal bleeding: a prospective evaluation [abstract].  Gastrointest Endosc. 2001;  53 AB114
• 34 Onders R P, Mittendorf E A. Emerging role of laparoscopy in patients with chronic abdominal pain and assessment of late outcomes [abstract].  Gastroenterology. 2001;  120 A400
• 35 Ozawa S, Furukawa T, Wakabayasahi G, et al. Robotic-assisted laparoscopic esophageal surgery [abstract].  Gastroenterology. 2001;  120 A477