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Identification of risk factors for mucosal injury during laparoscopic Heller myotomy for achalasia.
- Source :
-
Surgical endoscopy [Surg Endosc] 2016 Feb; Vol. 30 (2), pp. 706-714. Date of Electronic Publication: 2015 Jun 20. - Publication Year :
- 2016
-
Abstract
- Background: Mucosal injury during myotomy is the most frequent complication seen with the Heller-Dor procedure for achalasia. The present study aimed to examine risk factors for such mucosal injury during this procedure.<br />Methods: This was a retrospective analysis of patients who underwent the laparoscopic Heller-Dor procedure for achalasia at a single facility. Variables for evaluation included patient characteristics, preoperative pathophysiological findings, and surgeon's operative experience. Logistic regression was used to identify risk factors. We also examined surgical outcomes and the degree of patient satisfaction in relation to intraoperative mucosal injury.<br />Results: Four hundred thirty-five patients satisfied study criteria. Intraoperative mucosal injury occurred in 67 patients (15.4%). In univariate analysis, mucosal injury was significantly associated with the patient age ≥60 years, disease history ≥10 years, prior history of cardiac diseases, preoperative esophageal transverse diameter ≥80 mm, and surgeon's operative experience with fewer than five cases. In multivariate analysis involving these factors, the following variables were identified as risk factors: age ≥60 years, esophageal transverse diameter ≥80 mm, and surgeon's operative experience with fewer than five cases. The mucosal injury group had significant extension of the operative time and increased blood loss. However, there were no significant differences between the two groups in the incidence of reflux esophagitis or the degree of symptom alleviation postoperatively.<br />Conclusion: The fragile esophagus caused by advanced patient age and/or dilatation were risk factor for mucosal injury during laparoscopic Heller-Dor procedure. And novice surgeon was also identified as an isolated risk factor for mucosal injury.
- Subjects :
- Adult
Aged
Aged, 80 and over
Digestive System Surgical Procedures methods
Female
Follow-Up Studies
Humans
Laparoscopy methods
Logistic Models
Male
Middle Aged
Mucous Membrane injuries
Patient Satisfaction
Retrospective Studies
Risk Factors
Treatment Outcome
Digestive System Surgical Procedures adverse effects
Esophageal Achalasia surgery
Esophageal Sphincter, Lower surgery
Esophagus injuries
Intraoperative Complications etiology
Laparoscopy adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1432-2218
- Volume :
- 30
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Surgical endoscopy
- Publication Type :
- Academic Journal
- Accession number :
- 26092001
- Full Text :
- https://doi.org/10.1007/s00464-015-4264-0