Esófago porcino: modelo ex vivo de entrenamiento laparoscópico para la miotomía de Heller y funduplicatura de Dor / Porcine esophagus: ex vivo laparoscopic training model for Heller's myotomy and Dor's funduplication

El dominio de procedimientos avanzados en laparoscopia es fundamental para los cirujanos, por ello el entrenamiento es imprescindible. La miotomía de Heller y funduplicatura de Dor requieren el desarrollo de habilidades y destrezas para realizar la cirugía de forma segura y eficaz, superar la curva de aprendizaje es un reto para el cirujano en formación, por lo que se propone el esófago porcino como modelo ex vivo de entrenamiento laparoscópico, con el fin de permitir desarrollar las habilidades necesarias y así llevar a cabo con éxito el procedimiento quirúrgico.Objetivo : Aplicar el esófago porcino como modelo ex vivo para el entrenamiento laparoscópico de la miotomía de Heller y funduplicatura de Dor.Métodos : Se realizó un estudio prospectivo, experimental y longitudinal, aplicado en un período de 17 semanas, en sesiones de 1 hora cada una, una sesión por semana.Resultados : Se llevaron a cabo 17 prácticas realizadas por el autor, evaluadas por cirujanos expertos, observando un aumento de la puntuación obtenida en la escala GOALS y disminución del tiempo de ejecución a medida que aumentaba el número de prácticas con una correlación altamente significativa, según la tau-B de Kendall (p=0,000).Conclusión : El modelo ex vivo permitió recrear la mayoría de los pasos quirúrgicos y demostró ser una herramienta útil y valiosa, disminuyendo el tiempo de ejecución del procedimiento y aumentando significativamente las habilidades laparoscópicas(AU)

Mastery of advanced procedures in laparoscopy is important for surgeons, therefore training is essential. Heller's myotomy and Dor's fundoplication require the development of abilities and skills to perform the surgery safely and effectively, overcoming the learning curve is a challenge for the surgeon in training, so the porcine esophagus is proposed as an ex vivo model of laparoscopic training in order to develop the necessary skills to successfully carry out the surgical procedure. Objective: To apply the porcine esophagus as an ex vivo model for laparoscopic training of Heller's myotomy and Dor's fundoplication. Methods: A prospective, experimental and longitudinal study was carried out, applied by the authors in a period of 17 weeks, in sessions of 1 hour each, one session per week. Results: 17 practices carried out by the author were carried out, evaluated by expert surgeons, observing an increase in the score obtained on the GOALS scale and a decrease in execution time as the number of practices with a high significant influence increase, according to Kendall's tau-B (p=0.000). Conclusion: The ex vivo model allowed recreating most of the surgical steps and stood out as a useful and valuable tool, decreasing the execution time of the procedure and significantly increasing laparoscopic skills(AU)

Safety and Outcome of Laparoscopic Heller’s Cardiomyotomy with Intraoperative Endoscopic Assessment and Dor’s Fundoplication in Primary Achalasia Cardia: A Single-center Prospective Study

Introduction: Achalasia cardia is a primary esophageal motility disorder of an unknown etiology, characterized by abnormal peristalsis of the esophageal body and the absence of relaxation of the lower esophageal sphincter. Laparoscopic Heller cardiomyotomy is the surgical procedure of choice for achalasia cardia. Aim: The aim of the study was to the immediate safety and long-term efficacy of laparoscopic Heller’s cardiomyotomy with intraoperative endoscopy and Dor’s anterior partial fundoplication in patients with achalasia cardia. Materials and Methods: In this prospective study, laparoscopic Heller’s myotomy with intraoperative endoscopy and anterior Dor’s fundoplication were performed in all achalasia cardia patients. Patients’ demographic, clinical features such as dysphagia grade and Eckardt score, intraoperative, post-operative parameters, and response to treatment on follow-up were analyzed. Results: In 14 patients, 10 were females (71%), the mean age was 37±14.96 years. Mean pre-operative modified Takita’s dysphagia grade was 2.93±0.73. Endoscopic classic findings and barium swallow bird beak sign were diagnostic in all cases. Preoperative Eckardt score was 8.93±1.44. Eckardt score at discharge was 0.43±0.51 and at 12th month was 0.21±0.43. On analysis, there was a significant improvement in pre-operative values of modified Takita’s dysphagia grade and Eckardt score to normal values postoperatively (P < 0.0001) and the durable effect was persistently observed in 3rd and 6th, 9th, and 12th-month follow-up. Conclusion: Laparoscopic Heller’s myotomy with intraoperative endoscopy and Dor’s fundoplication are safe and effective with significant improvement in post-operative Takita’s dysphagia score and Eckardt score.

Cirugía laparoscópica mediante la técnica de Heller-Dor en pacientes con acalasia / Laparoscopic surgery by Heller-Dor technique in patients with achalasia

Se efectuó un estudio descriptivo y prospectivo de 8 pacientes con acalasia, atendidos en el Hospital Clinicoquirúrgico Docente Dr Joaquín Castillo Duany de Santiago de Cuba, desde enero del 2006 hasta agosto del 2010, a fin de demostrar la efectividad de la técnica de Heller-Dor en el tratamiento de dicha afección mediante el uso de la cirugía mínimamente invasiva. En la casuística primaron la disfagia y la regurgitación como los síntomas más comunes, el grupo etario de 31-45 años y el sexo femenino. El tiempo quirúrgico osciló entre 65 y 95 minutos, hubo tolerancia a la vía oral en las primeras 6 horas, la estancia hospitalaria promedio fue de 31,6 horas y solo un paciente presentó complicación tardía, con evolución satisfactoria en todos los casos. Se demostró la eficacia de la esofagocardiomiotomía de Heller con funduplicatura de Dor por laparoscopia

A descriptive and prospective study was carried out in 8 patients with achalasia treated in Dr Joaquín Castillo Duany Teaching Clinical Surgical Hospital of Santiago de Cuba from January 2006 to August 2010 in order to demonstrate the effectiveness of Heller-Dor technique in the treatment of this condition by using minimally invasive surgery. Dysphagia and regurgitation as the most common symptoms, age group of 31-45 years and females prevailed in the case material. The surgical time ranged between 65 and 95 minutes; there was oral tolerance in the first 6 hours; the average hospital stay was 31.6 hours and only one patient had late complication, with satisfactory outcome in all cases. The efficacy of Heller's esophagocardiomyotomy with Dor fundoplication by laparoscopy was confirmed

Miotomía de Heller con fundoplicatura de dor por laparoscopia para el tratamiento de la acalasia: resultado de 17 años de experiencia / Laparoscopic Heller myotomy with dor fundoplication for achalasia: result of 17 years experience

Exponer la experiencia en el manejo de la acalasia en el Servicio de Cirugía General del Centro Médico “Dr. Rafael Guerra Méndez”. Valencia-Venezuela. Estudio retrospectivo, descriptivo y analítico, basado en la revisión de los formatos de cirugía laparoscópica previamente diseñados para tal fin, de los pacientes ingresados entre el año 1992 y 2009, con el diagnóstico de acalasia. Se evaluaron las variables sexo, edad, síntomas, tiempo de evolución de los síntomas, tiempo quirúrgico y complicaciones. Los resultados se muestran en frecuencia absoluta y relativa. Se realizaron 27 procedimientos a predominio del sexo masculino (55.56%). El grupo de edad más frecuente fue la tercera y cuarta década (más del 70%). La sintomatología más frecuente fue disfagia, regurgitación y dolor torácico, presente en la mayoría de los casos. La distribución del tiempo quirúrgico promedio fue 158 minutos ± 32.35 minutos. Hubo 2 complicaciones intraoperatorias (7.4%), y complicaciones postoperatorias menores. No hubo mortalidad. Controles periódicos 3 pacientes (11.11%) necesitaron dilataciones postoperatorias pos disfagia. El abordaje laparoscópico para la acalasia es un método seguro y confiable para el tratamiento de la misma. Se necesita mayor seguimiento para evaluación de la técnica.

To expose the experience in the management of achalasia at General Surgery Service of Centro Médico “Dr. Rafael Guerra Mendez”. Valencia-Venezuela. This is a retrospective and analytical study based on the review of laparoscopic surgical records previously designed, of patients admitted between 1992 and 2009 with diagnosis of achafasia. We evaluated gender, age, symptoms and its evolution, surgical time and complications. The results are presented as absolute and relative frequency measurements. There were performed 27 procedures predominantely on male patients (55,56%). The age group more frequent affected was between 3rd and 4th decade (more than 70%). In most cases, symptomatology was dysphagia, regurgitation and thoracic pain, presented in 70% of patients, from 3 up to 9 years with this clinic. Average surgical time was 158 minutes ± 32,35. There were 2 intraoperative complications (7,4%), and minor postoperative complications. There was not mortality. Three patients (11,11%) need postoperative dilatations for dysphagia. Laparoscopic approach is a sale and reliable method in the treatment of achalasia. A longer follow-up is needed to evaluate this technique.

Lapraroscopic Surgery for the Treatment of Achalasia / 医学研究杂志

Objective To investigate the safety and feasibility of lapraroscopic Heller myotomy combined with Dor fundoplication surgery. Methods Three cases with achalasia have been treated with laproroscopic Heller-Dor surgery since February, 2005. Before surgery, patients were examined for generally esophageal barium meal and esophageal manometry. Results The operation time ranged from 110 and 120 minutes with the bleeding volumes between 40 to 50 ml, and the hospitalized time for patients post operation was 6 to 7 days. During a month after surgery, the patients showed the normal lower esophageal sphincter pressure and remnant pressure, increased the rate of relaxation,disappeared reversed peristalsis and gastroesophageal reflux, and no recurred symptoms. Conclusions In comparison to conventional surgery, Heller-Dor procedure results in smaller wound, less pain, fewer complications, faster recovery, shorter hospitalized days, and better therapeutic effectiveness. The Heller-Dor procedure is safe and feasible.