{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T12:26:03Z","timestamp":1784031963227,"version":"3.55.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T00:00:00Z","timestamp":1681344000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T00:00:00Z","timestamp":1681344000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009367","name":"Mansoura University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009367","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Today"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To investigate the risk factors and outcomes of mucosal perforation (MP) during laparoscopic Heller myotomy (LHM) in patients with achalasia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a retrospective analysis of patients who underwent LHM for achalasia at a single facility.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Among 412 patients who underwent LHM for achalasia, MP was identified in 52 (12.6%). Old age, long disease duration, low albumin level, an esophageal transverse diameter \u2009&gt;\u20096\u00a0cm, and a sigmoid-shaped esophagus were found to be independent predictors of MP. These factors were assigned a pre-operative score to predict the perforation risk. MP had a significant impact on intra and post-operative outcomes. Gastric side perforation was associated with a higher incidence of reflux symptoms, whereas esophageal-side perforation had a higher incidence of residual dysphagia.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Many risk factors for MP have been identified. Correctable parameters like low serum albumin should be resolved prior to surgery, while uncorrectable parameters like old age and a sigmoid-shaped esophagus should be managed by experienced surgeons in high-volume centers. Implementing these recommendations will help decrease the incidence and consequences of this serious complication.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00595-023-02680-2","type":"journal-article","created":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T11:04:48Z","timestamp":1681383888000},"page":"1225-1235","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Mucosal injury during laparoscopic Heller cardiomyotomy: risk factors and impact on surgical outcomes"],"prefix":"10.1007","volume":"53","author":[{"given":"El-Sayed Abou","family":"El-Magd","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elgeidie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Abbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youssif","family":"Elmahdy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahem Lotfy","family":"Abulazm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,4,13]]},"reference":[{"issue":"7","key":"2680_CR1","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1080\/17474124.2018.1481748","volume":"12","author":"F Schlottmann","year":"2018","unstructured":"Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol. 2018;12(7):711\u201321. https:\/\/doi.org\/10.1080\/17474124.2018.1481748.","journal-title":"Expert Rev Gastroenterol Hepatol"},{"issue":"2","key":"2680_CR2","doi-asserted-by":"publisher","first-page":"72","DOI":"10.1177\/145749691110000202","volume":"100","author":"I Gockel","year":"2011","unstructured":"Gockel I, Sgourakis G, Drescher DG, Lang H. Impact of minimally invasive surgery in the spectrum of current achalasia treatment options. Scand J Surg. 2011;100(2):72\u20137. https:\/\/doi.org\/10.1177\/145749691110000202.","journal-title":"Scand J Surg"},{"issue":"8","key":"2680_CR3","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1038\/ajg.2013.196","volume":"108","author":"MF Vaezi","year":"2013","unstructured":"Vaezi MF, Pandolfino JE, Vela MF. ACG clinical guideline: diagnosis and management of achalasia. Am J Gastroenterol. 2013;108(8):1238\u201349. https:\/\/doi.org\/10.1038\/ajg.2013.196.","journal-title":"Am J Gastroenterol"},{"issue":"9","key":"2680_CR4","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.14309\/ajg.0000000000000731","volume":"115","author":"MF Vaezi","year":"2020","unstructured":"Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT. ACG clinical guidelines: diagnosis and management of achalasia. Am J Gastroenterol. 2020;115(9):1393\u2013411. https:\/\/doi.org\/10.14309\/ajg.0000000000000731.","journal-title":"Am J Gastroenterol"},{"issue":"2","key":"2680_CR5","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1055\/a-0863-4917","volume":"144","author":"BHA von Rahden","year":"2019","unstructured":"von Rahden BHA. Current treatment of achalasia 2019. Zentralbl Chir. 2019;144(2):163\u201370. https:\/\/doi.org\/10.1055\/a-0863-4917.","journal-title":"Zentralbl Chir"},{"issue":"1","key":"2680_CR6","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.jamcollsurg.2008.08.027","volume":"208","author":"VA Williams","year":"2009","unstructured":"Williams VA, Peters JH. Achalasia of the esophagus: a surgical disease. J Am Coll Surg. 2009;208(1):151\u201362. https:\/\/doi.org\/10.1016\/j.jamcollsurg.2008.08.027.","journal-title":"J Am Coll Surg"},{"issue":"2","key":"2680_CR7","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1053\/j.gastro.2010.06.024","volume":"139","author":"DL Francis","year":"2010","unstructured":"Francis DL, Katzka DA. Achalasia: update on the disease and its treatment. Gastroenterology. 2010;139(2):369\u201374. https:\/\/doi.org\/10.1053\/j.gastro.2010.06.024.","journal-title":"Gastroenterology"},{"issue":"1","key":"2680_CR8","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jviscsurg.2018.01.006","volume":"155","author":"A Valverde","year":"2018","unstructured":"Valverde A, Cahais J, Lupinacci R, Goasguen N, Oberlin O. Laparoscopic Heller myotomy. J Visc Surg. 2018;155(1):59\u201364. https:\/\/doi.org\/10.1016\/j.jviscsurg.2018.01.006.","journal-title":"J Visc Surg"},{"issue":"23","key":"2680_CR9","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1056\/NEJMoa1905380","volume":"381","author":"YB Werner","year":"2019","unstructured":"Werner YB, Hakanson B, Martinek J, Repici A, von Rahden BHA, Bredenoord AJ, et al. Endoscopic or surgical myotomy in patients with idiopathic achalasia. N Engl J Med. 2019;381(23):2219\u201329. https:\/\/doi.org\/10.1056\/NEJMoa1905380.","journal-title":"N Engl J Med"},{"issue":"12","key":"2680_CR10","doi-asserted-by":"publisher","first-page":"1817","DOI":"10.1038\/ajg.2012.332","volume":"107","author":"KL Lynch","year":"2012","unstructured":"Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol. 2012;107(12):1817\u201325. https:\/\/doi.org\/10.1038\/ajg.2012.332.","journal-title":"Am J Gastroenterol"},{"issue":"2","key":"2680_CR11","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1007\/s00464-015-4264-0","volume":"30","author":"K Tsuboi","year":"2016","unstructured":"Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S, et al. Identification of risk factors for mucosal injury during laparoscopic Heller myotomy for achalasia. Surg Endosc. 2016;30(2):706\u201314. https:\/\/doi.org\/10.1007\/s00464-015-4264-0.","journal-title":"Surg Endosc"},{"issue":"6","key":"2680_CR12","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1089\/lap.2006.16.587","volume":"16","author":"F Pereira-Graterol","year":"2006","unstructured":"Pereira-Graterol F, Moreno-Portillo M. Distal esophageal perforation repair during laparoscopic esophagomyotomy: evaluation of outcomes and review of surgical technique. J Laparoendosc Adv Surg Tech A. 2006;16(6):587\u201392. https:\/\/doi.org\/10.1089\/lap.2006.16.587.","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"12","key":"2680_CR13","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1007\/s11605-016-3276-y","volume":"20","author":"R Salvador","year":"2016","unstructured":"Salvador R, Spadotto L, Capovilla G, Voltarel G, Pesenti E, Longo C, et al. Mucosal perforation during laparoscopic Heller myotomy has no influence on final treatment outcome. J Gastrointest Surg. 2016;20(12):1923\u201330. https:\/\/doi.org\/10.1007\/s11605-016-3276-y.","journal-title":"J Gastrointest Surg"},{"issue":"4","key":"2680_CR14","doi-asserted-by":"publisher","first-page":"1856","DOI":"10.1007\/s00464-019-06952-2","volume":"34","author":"E Shemmeri","year":"2020","unstructured":"Shemmeri E, Aye RW, Farivar AS, Bograd AJ, Louie BE. Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score. Surg Endosc. 2020;34(4):1856\u201362. https:\/\/doi.org\/10.1007\/s00464-019-06952-2.","journal-title":"Surg Endosc"},{"key":"2680_CR15","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1186\/s13741-018-0094-7","volume":"7","author":"KM Knuf","year":"2018","unstructured":"Knuf KM, Maani CV, Cummings AK. Clinical agreement in the American Society of Anesthesiologists physical status classification. Perioper Med (Lond). 2018;7:14. https:\/\/doi.org\/10.1186\/s13741-018-0094-7.","journal-title":"Perioper Med (Lond)"},{"issue":"2","key":"2680_CR16","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1007\/s00464-005-0365-5","volume":"20","author":"N Omura","year":"2006","unstructured":"Omura N, Kashiwagi H, Ishibashi Y, Yano F, Tsuboi K, Kawasaki N, et al. Laparoscopic Heller myotomy and Dor fundoplication for the treatment of achalasia. Assessment in relation to morphologic type. Surg Endosc. 2006;20(2):210\u20133. https:\/\/doi.org\/10.1007\/s00464-005-0365-5.","journal-title":"Surg Endosc"},{"key":"2680_CR17","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1007\/s11605-009-1013-5","volume":"14","author":"GR Roll","year":"2010","unstructured":"Roll GR, Rabl C, Ciovica R, Peeva S, Campos GM. A controversy that has been tough to swallow: is the treatment of achalasia now digested? J Gastrointest Surg. 2010;14:S33-45. https:\/\/doi.org\/10.1007\/s11605-009-1013-5.","journal-title":"J Gastrointest Surg"},{"issue":"4","key":"2680_CR18","doi-asserted-by":"publisher","first-page":"1191","DOI":"10.1016\/j.athoracsur.2005.04.008","volume":"80","author":"S Deb","year":"2005","unstructured":"Deb S, Deschamps C, Allen MS, Nichols FC 3rd, Cassivi SD, Crownhart BS, et al. Laparoscopic esophageal myotomy for achalasia: factors affecting functional results. Ann Thorac Surg. 2005;80(4):1191\u20134. https:\/\/doi.org\/10.1016\/j.athoracsur.2005.04.008.","journal-title":"Ann Thorac Surg"},{"issue":"8","key":"2680_CR19","doi-asserted-by":"publisher","first-page":"870","DOI":"10.1001\/archsurg.136.8.870","volume":"136","author":"MG Patti","year":"2001","unstructured":"Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S, et al. Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg. 2001;136(8):870\u20137. https:\/\/doi.org\/10.1001\/archsurg.136.8.870.","journal-title":"Arch Surg"},{"issue":"3","key":"2680_CR20","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1007\/s00464-005-0069-x","volume":"20","author":"A Iqbal","year":"2006","unstructured":"Iqbal A, Haider M, Desai K, Garg N, Kavan J, Mittal S, et al. Technique and follow-up of minimally invasive Heller myotomy for achalasia. Surg Endosc. 2006;20(3):394\u2013401. https:\/\/doi.org\/10.1007\/s00464-005-0069-x.","journal-title":"Surg Endosc"},{"issue":"5","key":"2680_CR21","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1097\/01.sla.0000217524.75529.2d","volume":"243","author":"CD Smith","year":"2006","unstructured":"Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg. 2006;243(5):579\u201384. https:\/\/doi.org\/10.1097\/01.sla.0000217524.75529.2d.","journal-title":"Ann Surg"},{"issue":"5","key":"2680_CR22","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1111\/j.1572-0241.1999.01062.x","volume":"94","author":"EH Metman","year":"1999","unstructured":"Metman EH, Lagasse JP, d\u2019Alteroche L, Picon L, Scotto B, Barbieux JP. Risk factors for immediate complications after progressive pneumatic dilation for achalasia. Am J Gastroenterol. 1999;94(5):1179\u201385. https:\/\/doi.org\/10.1111\/j.1572-0241.1999.01062.x.","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"2680_CR23","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1007\/s004649900363","volume":"11","author":"M Morino","year":"1997","unstructured":"Morino M, Rebecchi F, Festa V, Garrone C. Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy. Surg Endosc. 1997;11(4):359\u201361. https:\/\/doi.org\/10.1007\/s004649900363.","journal-title":"Surg Endosc"},{"issue":"7","key":"2680_CR24","doi-asserted-by":"publisher","first-page":"e0180515","DOI":"10.1371\/journal.pone.0180515","volume":"12","author":"F Yano","year":"2017","unstructured":"Yano F, Omura N, Tsuboi K, Hoshino M, Yamamoto S, Akimoto S, et al. Learning curve for laparoscopic Heller myotomy and Dor fundoplication for achalasia. PLoS ONE. 2017;12(7):e0180515. https:\/\/doi.org\/10.1371\/journal.pone.0180515.","journal-title":"PLoS ONE"},{"issue":"2","key":"2680_CR25","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1007\/s11605-008-0687-4","volume":"13","author":"KR Finan","year":"2009","unstructured":"Finan KR, Renton D, Vick CC, Hawn MT. Prevention of post-operative leak following laparoscopic Heller myotomy. J Gastrointest Surg. 2009;13(2):200\u20135. https:\/\/doi.org\/10.1007\/s11605-008-0687-4.","journal-title":"J Gastrointest Surg"},{"issue":"11","key":"2680_CR26","doi-asserted-by":"publisher","first-page":"2270","DOI":"10.1023\/a:1026660921776","volume":"44","author":"MG Patti","year":"1999","unstructured":"Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999;44(11):2270\u20136. https:\/\/doi.org\/10.1023\/a:1026660921776.","journal-title":"Dig Dis Sci"}],"container-title":["Surgery Today"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00595-023-02680-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00595-023-02680-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00595-023-02680-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,26]],"date-time":"2023-10-26T02:02:35Z","timestamp":1698285755000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00595-023-02680-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,13]]},"references-count":26,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["2680"],"URL":"https:\/\/doi.org\/10.1007\/s00595-023-02680-2","relation":{},"ISSN":["0941-1291","1436-2813"],"issn-type":[{"value":"0941-1291","type":"print"},{"value":"1436-2813","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,13]]},"assertion":[{"value":"16 January 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 March 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 April 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"We have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"All procedures were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or a substitute for inclusion in this study was obtained from all patients.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human rights statement and informed consent"}}]}}