Resumo
Laparoscopic techniques have provided a new dimension to correct functional disorders of the esophagus, which has stimulated some investigators to recently report the use of laparoscopic cardiomyotomy in the treatment of esophageal achalasia. Now, a new instrument has been added to the current laparoscopic technique to offer a safer and easier method to proceed complete myotomy. After the dissection of the esophagogastric junction, a special catheter is introduced reaching the stomach. lt has an illuminated 10 cm extremity connected to a light source. lts withdrawal allows to visualize every muscle circular fiber by transillumination withan improved view provide by the laparoscopic optic system lens. This condition modifies the operative surgeon s attitude offering a better controlled situation over the procedure. The use of transillumination o fthe esophagogastric junction provides a good identification of the mucosa e submucosa avoiding the risk of esophageal perforation. It also helps to perform a complete myotomy preventing the ocurrence of persistent disphagia in the postoperative period. Cardiomyotomy with parcial fundoplication is possible by videolaparoscopic approach, now made easier with transillumination. This technique is safe and the functional results are similar to those observed in the literature for conventional open procedures, with the obvious advantages of the minimally invasive approach.
Achalasia; Cardiomyotomy; Megaesophagus
Achalasia; Cardiomyotomy; Megaesophagus
NOTA PRÉVIA
Acalasia do esôfago: miotomia com transiluminação
Esophageal achalasia: myotomy with transillumination
Pablo Roberto Miguel, TCBC-RS; Marcus Reuschl; André Luiz Moreira da Rosa
Cirurgião Videolaparoscopista do Hospital Mãe de Deus
Endereço para correspondência Endereço para correspondência: Dr. Pablo Roberto Miguel Hospital Mãe de Deus Serviço e Cirurgia Laparoscópica Rua Costa, 30 cj. 502 90110-270 - Porto Alegre - RS
ABSTRACT
Laparoscopic techniques have provided a new dimension to correct functional disorders of the esophagus, which has stimulated some investigators to recently report the use of laparoscopic cardiomyotomy in the treatment of esophageal achalasia. Now, a new instrument has been added to the current laparoscopic technique to offer a safer and easier method to proceed complete myotomy. After the dissection of the esophagogastric junction, a special catheter is introduced reaching the stomach. lt has an illuminated 10 cm extremity connected to a light source. lts withdrawal allows to visualize every muscle circular fiber by transillumination withan improved view provide by the laparoscopic optic system lens. This condition modifies the operative surgeon s attitude offering a better controlled situation over the procedure. The use of transillumination o fthe esophagogastric junction provides a good identification of the mucosa e submucosa avoiding the risk of esophageal perforation. It also helps to perform a complete myotomy preventing the ocurrence of persistent disphagia in the postoperative period. Cardiomyotomy with parcial fundoplication is possible by videolaparoscopic approach, now made easier with transillumination. This technique is safe and the functional results are similar to those observed in the literature for conventional open procedures, with the obvious advantages of the minimally invasive approach.
Key words: Achalasia; Cardiomyotomy; Megaesophagus.
Texto completo disponível apenas em PDF.
Full text available only in PDF format.
Recebido em 1/2/99
Aceito para publicação em 4/10/99
Trabalho realizado no Serviço de Cirurgia Laparoscópica do Hospital Mãe de Deus.
- 1. Domene CE, Santo MA, Onari P, et al - Laparoscopic treatment of megaesophagus. Results of cardiomyectomy with fundoplication. ABCD Arq Bras Cir Dig 1997;12(3/4):34-38.
- 2. Miguel PR, Reusch M, Rosa ALM - Laparoscopic fundoplication: analysis of 115 patients. In Topozlu C, Tekant Y (eds) Euro Asian Congress of Endoscopic Surgery. Monduzzi Editore SpA.- Bologna (Italy), 1997, pp 141-144.
- 3. Vogt D, Pitcher D, Zucher K, et al - Successful treatment of esophageal achalasia with laparoscopic Heller myotomy and Toupet fundoplication. Am J Surg 1997;177:709-714.
Datas de Publicação
-
Publicação nesta coleção
24 Nov 2009 -
Data do Fascículo
Dez 1999
Histórico
-
Recebido
01 Fev 1999 -
Aceito
04 Out 1999
