Can intraoperative manometry influence the outcome of the surgical treatment of achalasia?

Journal of Mind and Medical Sciences Volume 6 | Issue 2 Article 23 2019 Can intraoperative manometry influence the outcome of the surgical treatment of achalasia? Lucian Alecu Iulian Slavu Adrian Tulin Daniela Mihaila Robert Ivascu See next page for additional authors Follow this and additional works at: https://scholar.valpo.edu/jmms Part of the Gastroenterology Commons, Public Health Commons, and the Surgery Commons Recommended Citation Alecu, Lucian; Slavu, Iulian; Tulin, Adrian; Mihaila, Daniela; Ivascu, Robert; and Mirea, Liliana (2019) "Can intraoperative manometry influence the outcome of the surgical treatment of achalasia?," Journal of Mind and Medical Sciences: Vol. 6 : Iss. 2 , Article 23. DOI: 10.22543/7674.62.P346350 Available at: https://scholar.valpo.edu/jmms/vol6/iss2/23 This Research Article is brought to you for free and open access by ValpoScholar. It has been accepted for inclusion in Journal of Mind and Medical Sciences by an authorized administrator of ValpoScholar. For more information, please contact a ValpoScholar staff member at . Can intraoperative manometry influence the outcome of the surgical treatment of achalasia? Authors Lucian Alecu, Iulian Slavu, Adrian Tulin, Daniela Mihaila, Robert Ivascu, and Liliana Mirea This research article is available in Journal of Mind and Medical Sciences: https://scholar.valpo.edu/jmms/vol6/iss2/23 https://scholar.valpo.edu/jmms/ https://proscholar.org/jmms/ ISSN: 2392-7674 J Mind Med Sci. 2019; 6(2): 346-350 doi: 10.22543/7674.62.P346350 Received for publication: February 26, 2019 Accepted: May 22, 2019 Research article Can intraoperative manometry influence the outcome of the surgical treatment of achalasia? Lucian Alecu1, Iulian Slavu2, Adrian Tulin1, Daniela Mihaila1, Robert Ivascu3, Liliana Mirea4 1 Agrippa Ionescu Clinical Emergency Hospital, Department of General Surgery, Bucharest, Romania Clinical Emergency Hospital Bucharest, Department of General Surgery, Bucharest, Romania 3 Elias University Emergency Hospital, The Anesthesiology and Critical Care Unit, Bucharest, Romania 4 Carol Davila University of Medicine and Pharmacy, The Emergency Hospital of Bucharest, Romania 2 Abstract Introduction. Achalasia is defined as incomplete or even absent relaxation of the lower esophageal sphincter secondary to the chronic degeneration of unspecified etiology of the myenteric nerve plexus. Material and method. The retrospective study extended over 1 year. The collected variables were: age, sex, type of surgical intervention, intraoperative manometry results, and postoperative complications. Results. We identified 8 patients. The mean operative time was 100 minutes. The use of manometry determined an increase in time of 30 to 40 minutes. Manometry was successfully achieved in all cases, although in one case the sensor could not pass through the lower esophagus, so a prior pneumatic dilation was required. Manometry has proven useful during fundoplication as it offers a direct view of the pressure produced when knots set at 12 - 15 mmHg with a length of 45 cm were tightened. Of the 8 patients, 6 required an increase in the length of the resection of the esophagus after the results of the intraoperative manometry were reviewed. Conclusion. In our opinion, after reviewing our experience and the literature data, intraoperative manometry should become a standard procedure in the laparoscopic treatment of achalasia. Keywords  Highlights ✓ The use of manometry in the treatment of achalasia seems to be convincing. manometry, achalasia, myotomy, surgical treatment ✓ Although the expense is higher, it are still less than having to reoperate on a patient due to persistent symptoms. To cite this article: Alecu L, Slavu I, Tulin A, Mihaila D, Ivascu R, Mirea L. Can intraoperative manometry influence the outcome of the surgical treatment of achalasia? J Mind Med Sci. 2019; 6(2): 346-350. DOI: 10.22543/7674.62.P346350 *Corresponding author: Slavu Iulian, Clinical Emergency Hospital Bucharest, Department of General Surgery, Bucharest, Romania E-mail: Lucian Alecu et al. Introduction Materials and Methods Achalasia is defined as incomplete or even absent relaxation of the lower esophageal sphincter secondary to the chronic degeneration of unspecified etiology of the myenteric nerve plexus (1). The global incidence is 1.6 per 100,000 inhabitants. If left undiagnosed and untreated, in time, it can lead to increased rates of esophageal cancer, simultaneously decreasing the patient’s quality of life due to dysphagia (2). This retrospective analysis was conducted at a single institution. Data were collected over 1 year (01.01.201801.01.2019) and included: age, sex, type of surgical intervention, intraoperative manometry results, and postoperative complications. Data were retrieved from “Agrippa Ionescu” Clinical Emergency Hospital, Bucharest, Romania. We identified 8 qualifying patients during the selected time period. All had been diagnosed with achalasia and were operated on through a laparoscopic approach. The length of myotomy varied with each patient as indicated by the pressure areas confirmed with the aid of intraoperative manometry. All surgical interventions were completed through an anterior Dor fundoplication. The Dor fundoplication allows the sides of myotomy to remain separated, thus obtaining a good anti-reflux mechanism. As the stomach was tightened around the esophagus, the pressures were recorded and the technique adopted. A tenlumen probe with a 10 mm diameter was used. The cathether was marked to constantly evaluate its position regarding the depth and angle of rotation with respect to the pressure sensors. The sensors which recorded the pressure waves were placed circumferencially in order to obtain a 3D image of the pressures produced by the lower esophageal sensor. The diagnostic method of choice for this pathology is esophageal manometry and endoscopy. The gold treatment involves surgical resection of the circular muscle fibers which form the inferior esophageal sphincter through the technique of Heller myotomy, first described over 100 years ago when it was first practiced through a transthoracic approach (2). This procedure has undergone multiple changes since then and, at present, can be successfully performed through a laparoscopic approach, completed through a partial Dor (anterior) or Toupet (posterior) fundoplication. Another option is to perform a Nissen fundoplication on 360% to protect the exposed submucosal portion of the esophagus and to prevent any reflux disease, since the inferior esophageal sphincter is partially redone. Although the procedure has a success rate of up to 90% in symptom relief, 10% of the patients complain about the persistence of symptoms, most often due to the incomplete resection of the circular muscle fibers at the level of the esogastric junction. Macroscopically, an exact approximation of the resection length of these fibers is difficul (...truncated)