Video-assisted thoracoscopic lower esophageal myotomy in the management of achalasia: A report of 21 cases
- VernacularTitle:电视胸腔镜食管下段肌层切开术(改良Heller术)治疗贲门失弛缓症(附21例报告)
- Author:
Yuqing HUANG
;
Xiaogang LI
;
Jun LIU
- Publication Type:Journal Article
- Keywords:
Achalasia;
Thoracoscopy;
Esophagus
- From:Chinese Journal of Minimally Invasive Surgery
2005;0(08):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the practicability of video-assisted thoracoscopic lower esophageal myotomy in the treatment of achalasia. Methods A series of 21 consecutive patients with achalasia received video-assisted thoracoscopic lower esophageal myotomy between June 1997 and June 2005. The operation was performed under general anesthesia with double-lumen endotracheal intubation. The patient was positioned in the right lateral decubitus. Four thoracoscopic ports were introduced into the left hemithorax. A 6~11 cm incision at the lower esophageal sphincter with an extension to the gastric wall for 0.5~1 cm in length was made, to the depth of the submucous layer. A flexible gastroscope was inserted to check the integrity of the esophageal mucosa intraoperatively. No anti-reflux procedures were conducted. Results All the procedures were accomplished smoothly. The intraoperative hemorrhage volume was 50~100 ml (mean, 58 ml) and the operation time, 60~270 min (mean, 137 min). Esophageal mucosal perforation occurred in 3 patients, in 2 of whom the perforation was repaired thoracoscopically and in 1 of whom, through open thoracotomy. All the patients were recovered uneventfully, without severe complications. Follow-up checkups for 1~80 months found recurrence of dysphagia in 2 patients at 2 and 4 months after operation, respectively. Out of the 21 patients, the relief of dysphagia was classified as “excellent” results in 8 patients, “good” in 10 patients, “fair” in 1, and “poor” in 2, respectively. Conclusions Video-assisted thoracoscopic lower esophageal myotomy is a surgical approach with simple performance, minimal invasion, quick recovery and good efficacy. It can be employed as the first of choice for the management of achalasia.
