Document Detail


The effect of esophageal myotomy and myectomy on the lower esophageal sphincter pressure profile: intraoperative computerized manometry study.
MedLine Citation:
PMID:  16045577     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The surgical treatment of achalasia, based on Heller's myotomy is the procedure of choice to reduce the sphincterial high pressure zone, either by laparotomy or, most recently, by laparoscopy. What is the right length of the myotomy? Many authors have reported 10-15% postoperative residual dysphagia, due to the incomplete gastric myotomy and not to esophageal pouring. The aim of this study is to experimentally determine the modifications induced by Heller's myotomy and myectomy of the esophago-gastric junction on lower esophageal sphincter (LES) pressure profile, using a computerized manometric system. Myotomy of the esophageal portion of the LES (i.e. without dissection of the gastric fibers) has not modified the parameters considered, while the dissection of gastric fibers for at least 2-3 cm on the anterior gastric wall has created a significant modification of the LES pressure profile. Our observations seem to confirm and more clearly demonstrate the important role played by gastric fibers in sustaining the sphincteric HPZ. Moreover, analysis of our data, showed the need to always perform a complete myotomy. This was objectively shown during the intervention by means of intraoperative manometry, in order to significantly reduce the possibility of a dysphagic relapse, caused by inadequate treatment.
Authors:
N Di Martino; L Monaco; G Izzo; A Cosenza; F Torelli; A Basciotti; A Brillantino
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus / I.S.D.E     Volume:  18     ISSN:  1120-8694     ISO Abbreviation:  Dis. Esophagus     Publication Date:  2005  
Date Detail:
Created Date:  2005-07-27     Completed Date:  2005-12-20     Revised Date:  2013-05-20    
Medline Journal Info:
Nlm Unique ID:  8809160     Medline TA:  Dis Esophagus     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  160-5     Citation Subset:  IM    
Affiliation:
Second University of Naples, School of Medicine, Naples, Italy. natale.dimartino@unina2.it
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MeSH Terms
Descriptor/Qualifier:
Animals
Digestive System Surgical Procedures*
Esophageal Sphincter, Lower / physiology*,  surgery*
Esophagus / physiology*,  surgery*
Manometry
Models, Animal
Pressure
Swine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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