Erschienen in:
01.10.2013 | SSAT/SAGES Joint Symposium
Technical Pearls in Achalasia
verfasst von:
Barry Salky
Erschienen in:
Journal of Gastrointestinal Surgery
|
Ausgabe 10/2013
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Excerpt
The accepted length of the myotomy on the esophagus in achalasia is generally agreed by experienced esophageal surgeons to be between 6 and 8 cm. It is a good idea to actually measure this distance with some type of laparoscopic ruler in the beginning of ones’ experience with achalasia. There is no total agreement about the length of the myotomy onto the gastric wall. The accepted length among “experts” is between 1.5 and 3 cm. The principle here is to ensure that there are no gastric muscle fibers intact at the gastroesophageal junction. It is also known that the longer the myotomy, the more likely GERD will be a clinical problem postoperatively. Intraoperative endoscopy is a good way to make sure the myotomy is on the gastric wall. It has an added benefit in identifying any potential defects in the esophageal/gastric mucosa. In general, the surgeon cannot make the myotomy too long on the esophageal side, but that is not true on the gastric side. …
