OGBN P43 Mucosal injury following Laparoscopic Heller’s Cardio myotomy: Experience at a tertiary referral centre

Abstract

Abstract Background Heller’s cardio myotomy is a standard surgical procedure to treat patients with Achalasia Cardia. Mucosal injury is the most common serious complication of this procedure. The study was carried out to assess the impact of this serious complication on the patients who had surgery performed in this trust. Methods All patients who underwent Laparoscopic or Laparoscopic converted to open Heller’s myotomy for Achalasia Cardia mentioned in Flex Prod online patient record software were included in the study. Data of 57 patients who underwent the procedure was collected prospectively and analysed retrospectively. Results The data of total 57 patients was analysed for mucosal injuries in the perioperative period. 2 out of 3 patients suffered mucosal injuries were identified intraoperatively, subjected to laparoscopic converted to open exploratory laparotomy and repair. Both these patients recovered and were discharged home. Third patient presented day 6 postoperative period with symptoms of mucosal injury was subjected to laparotomy with repair of perforation over T-tube, had a prolonged admission and recovery leading to significant morbidity. Conclusions Iatrogenic mucosal perforation is the most important potentially serious perioperative complication of Hellers myotomy which can be avoided with careful and meticulous dissection. This procedure should ideally be performed at tertiary care centre where high volume of such cases is expected. Early intraoperative identification is key to good postoperative outcomes with late detection in postoperative period could lead to serious morbidities.