Seguridad de la miotomía laparoscópica y antirreflujo tipo dor en la acalasia

Resumen

Introduction. Laparoscopic surgery of achalasia is the “gold standard” of palliative treatment for this condition with which other endoscopic procedures such as pneumatic dilation or the emerging peroral endoscopic myotomy (POEM) are compared.Material and Methods. A retrospective study of 125 patients with achalasia operated on under minimally invasive surgery (March 1993 to March 2018), 101 of whom have been treated under longitudinal myotomy + laparoscopic Dor fundoplication, and have at least, one year follow-up since surgery. Immediate complications, according to Clavien-Dindo classification, as well as late com-plications have been evaluated.Results. Of the 101 patients included in the study, with an average follow-up of 12 years, the mean age was 50 years and 52% of them were women. There was no conversion to open surgery, neither traumatic splenectomies nor bleedings that required transfusion. Two iatrogenic elongations of brachial plexus (2%) were caused, both solved with postoperative rehabilitation. Intraopera-tive endoscopy was systematically performed, detecting mucosal perforation in 6 patients (6%), 3 of whom had been treated with preoperative botulinum toxin (50%), performing intraoperative laparoscopic mucosal suture. Of the 36 patients preoperatively trea-ted with botulinum toxin, 3 were perforated during surgery (8%), while of the 65 patients who were not administrated botulinum toxin, 3 (5%) were perforated (p=0,449).Conclusions. Laparoscopic Heller + Dor myotomy is a safe procedure because it shows a low intraoperative and postoperative complication rate. To our group it is the indication in every operable patient. We prefer to avoid injecting botulinum toxin preoperatively.