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Clinical and pathophysiological outcomes of the robotic-assisted Heller–Dor myotomy for achalasia: a single-center experience

  • G. PallabazzerEmail author
  • C. Peluso
  • N. de Bortoli
  • B. Solito
  • S. D’Imporzano
  • M. A. Belluomini
  • M. G. Bellomini
  • P. Giusti
  • D. Gianetri
  • S. Santi
Original Article
  • 27 Downloads

Abstract

Laparoscopic Heller myotomy and Dor fundoplication is considered a safe and effective treatment for achalasia. Robotic-assisted Heller–Dor procedure (RAHD) has emerged as an alternative approach due to improved visualization and fine motor control. The aim of this prospective study was to evaluate clinical, and functional results of RAHD. We evaluated a group of 66 patients with achalasia that underwent robotic-assisted Heller–Dor operation. Before treatment all patients underwent a diagnostic work-up such as upper endoscopy, esophageal barium swallow and high resolution manometry. The presence of postoperative gastroesophageal reflux disease was diagnosed by impedance and pH monitoring (MII-pH). Dysphagia improved in 92.4% of patients after treatment. Barium swallow series showed esophageal emptying in 100% of patients and a significant reduction of the esophageal diameter (p = 0.00235). Forty-five of 66 patients (68.2%) underwent upper endoscopy and 35 of 66 (53%) underwent MII-pH. Esophageal erosions were found in 4/45 (8,8%) and MII-pH showed abnormal results in 3/35 patients (8.6%). RAHD ensures a meticulous esophageal and gastric myotomy, allowing to visualize and divide each muscle fibers with a low rate of intraoperative and postoperative complications. resulting in turn in good clinical outcomes, radiological findings and functional results even if robotic tecnique definitely increases the surgical cost in the treatment of these functional esophageal disorders.

Keywords

Heller–Dor operation Myotomy Achalasia Robot Da Vinci pH-metry Dysphagia Fundoplication Impedance pH-metry Robotic surgery 

Notes

Compliance with ethical standards

Conflict of interest

Pallabazzer G, Peluso C, de Bortoli N, Solito B, D’Imporzano S, Belluomini MA, Bellomini MG, Giusti P, Gianetri D, Santi S. declare that they have no conflict of interest.

References

  1. 1.
    Goldblum JR, Rice TW, Richter JE (1996) Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology 111:648–654CrossRefGoogle Scholar
  2. 2.
    Park W, Vaezi MF (2005) Etiology and pathogenesis of achalasia: the current understanding. Am J Gastroenterol 100(6):1404–1414.  https://doi.org/10.1111/j.1572-0241.2005.41775.x CrossRefGoogle Scholar
  3. 3.
    Heller E (1914) Extramukose kardioplastik beim chronishen kardiospasmus mit dilatation des oesophagus. Mitt Grenzgeb Med Chir. 27:141–149Google Scholar
  4. 4.
    Shimi S, Nathanson LK, Cuschieri A (1991) Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb 36(3):152–154. http://europepmc.org.sci-hub.org/abstract/med/1833541. Accessed May 21, 2015
  5. 5.
    Horgan S, Galvani C, Gorodner M et al (2005) Robotic-assisted heller myotomy versus laparoscopic heller myotomy for the treatment of esophageal achalasia: multicenter study. J Gastrointest Surg 9:1020–1030.  https://doi.org/10.1016/j.gassur.2005.06.026 CrossRefGoogle Scholar
  6. 6.
    Perry KA, Kanji A, Drosdeck JM et al (2014) Efficacy and durability of robotic heller myotomy for achalasia: patient symptoms and satisfaction at long-term follow-up. Surg Endosc.  https://doi.org/10.1007/s00464-014-3576-9 Google Scholar
  7. 7.
    Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249(1):45–57.  https://doi.org/10.1097/sla.0b013e31818e43ab CrossRefGoogle Scholar
  8. 8.
    de Bortoli N, Martinucci I, Savarino E, Bellini M, Bredenoord AJ, Franchi R, Bertani L, Furnari M, Savarino V, Blandizzi C, Marchi S (2014) Proton pump inhibitor responders who are not confirmed as GERD patients with impedance and pH monitoring: who are they? Neurogastroenterol Motil 26(1):28–35.  https://doi.org/10.1111/nmo.12221 CrossRefGoogle Scholar
  9. 9.
    Kahrilas PJ, Bredenoord AJ, Fox M, Gyawali CP, Roman S, Smout AJ, Pandolfino JE (2015) The Chicago classification of esophageal motility disorders, v.30. Neurogastroenterol Motil 27(2):160–174.  https://doi.org/10.1111/nmo.12477 CrossRefGoogle Scholar
  10. 10.
    Zentilin P, Iiritano E, Dulbecco P et al (2006) Normal values of 24-h ambulatory intraluminal impedance combined with pH-metry in subjects eating a Mediterranean diet. Dig Liver Dis 38:226–232.  https://doi.org/10.1016/j.dld.2005.12.011 CrossRefGoogle Scholar
  11. 11.
    de Bortoli N, Martinucci I, Savarino E, Tutuian R, Frazzoni M, Piaggi P, Bertani L, Furnari M, Franchi R, Russo S, Bellini M, Savarino V, Marchi S (2015) Association between baseline impedance values and response proton pump inhibitors in patients with heartburn. Clin Gastroenterol Hepatol 13(6):1082-8.e1.  https://doi.org/10.1016/j.cgh.2014.11.035 CrossRefGoogle Scholar
  12. 12.
    Sifrim D, Castell D, Dent J, Kahrilas PJ (2004) Association between baseline impedance values and response proton pump inhibitors in patients with heartburn. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut 53(7):1024–1031.  https://doi.org/10.1136/gut.2003.033290 CrossRefGoogle Scholar
  13. 13.
    Martinucci I, de Bortoli N, Savarino E et al (2014) Esophageal baseline impedance levels in patients with pathophysiological characteristics of functional heartburn. Neurogastroenterol Motil 26(4):546–555.  https://doi.org/10.1111/nmo.12299 CrossRefGoogle Scholar
  14. 14.
    Galvani C, Gorodner MV, Moser F, Baptista M, Donahue P, Horgan S (2006) Laparoscopic heller myotomy for achalasia facilitated by robotic assistance. Surg Endosc Other Interv Tech 20:1105–1112.  https://doi.org/10.1007/s00464-005-0272-9 CrossRefGoogle Scholar
  15. 15.
    Melvin WS, Dundon JM, Talamini M, Horgan S (2005) Computer-enhanced robotic telesurgery minimizes esophageal perforation during Heller myotomy. Surgery 138(4):553–559.  https://doi.org/10.1016/j.surg.2005.07.025 CrossRefGoogle Scholar
  16. 16.
    Ortiz A, de Haro LF, Parrilla P, Lage A, Perez D, Munitiz V, Ruiz D, Molina J (2008) Very long-term objective evaluation of heller myotomy plus posterior partial fundoplication in patients with achalasia of the cardia. Ann Surg 247(2):258–264.  https://doi.org/10.1097/SLA.0b013e318159d7dd CrossRefGoogle Scholar
  17. 17.
    Burpee SE, Mamazza J, Schlachta CM et al (2005) Objective analysis of gastroesophageal reflux after laparoscopic Heller myotomy: an anti-reflux procedure is required. Surg Endosc Other Interv Tech 19(1):9–14.  https://doi.org/10.1007/s00464-004-8932-8 CrossRefGoogle Scholar
  18. 18.
    Oelschlager BK, Chang L, Pellegrini CA (2003) Improved outcome after extended gastric myotomy for achalasia. Arch Surg 138(5):490–495.  https://doi.org/10.1001/archsurg.138.5.490 (Discussion 495–497) CrossRefGoogle Scholar
  19. 19.
    Richards WO, Torquati A, Holzman MD et al (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240(3):405–412.  https://doi.org/10.1097/01.sla.0000136940.32255.51 (Discussion 412–415) CrossRefGoogle Scholar
  20. 20.
    Zaninotto G, Costantini M, Rizzetto C et al (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248(6):986–993.  https://doi.org/10.1097/SLA.0b013e3181907bdd CrossRefGoogle Scholar
  21. 21.
    Shaligram A, Unnirevi J, Simorov A, Kothari VM, Oleynikov D (2012) How does the robot affect outcomes?A retrospective review of open, laparoscopic, and roboticHeller myotomy for achalasia. Surg Endosc 26(4):1047–1050.  https://doi.org/10.1007/s00464-011-1994-5 CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.Unit of Esophageal Surgery, Department of SurgeryAzienda Ospedaliero Universitaria Pisana (AOUP)PisaItaly
  2. 2.Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and SurgeryAOUPPisaItaly
  3. 3.Division of Radiology, Department of Radiology, Vascular and Interventional Radiology and Nuclear MedicineAOUPPisaItaly

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