Page 163 - Read Online

Page 8 of 9 Sollie et al. Mini-invasive Surg 2020;4:80 I http://dx.doi.org/10.20517/2574-1225.2020.81

to esophageal perforations. In our experience of 50 patients undergoing this operation, we experienced a
0% perforation rate, median hospital stay of 1 day (range 1-3 days), median operation duration of 143 min
(range 84-301 min), and median blood loss of 25 mL (range 5-100 mL). Enhanced 3-D visualization and
increased mobility of surgical instruments provide surgeons with superior dexterity for performance of
intricate movements required for the dissection of the lower esophageal sphincter. The most frequently
reported postoperative symptom is reflux requiring pharmacologic management. The largest barrier for this
procedure remains the high cost. Limitations to the knowledge of this procedure include the make-up of
the literature being either case reports or retrospective studies. With the advent of POEM, the future role of
RHM remains unclear, as patients often prefer a procedure that is perceived to be less invasive. Advantages
of POEM compared to RHM is the absence of incisions and, in experienced hands, shorter operative
[35]
time; on the other hand, RHM permits the addition of a fundoplication to mitigate reflux . The hospital
[36]
length of stay and postoperative pain has been demonstrated to be similar between the two procedures .
The advantages and disadvantages of RHM should be investigated with comparative studies and, ideally,
randomized control trials.

DECLARATIONS
Authors’ contributions
Performed literature review, contributed to manuscript writing: Sollie ZW
Contributed to manuscript writing: Jiwani AZ
Project oversight, author of techniques, contributed to manuscript writing: Wei B

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2020.

REFERENCES
1. Gennaro N, Portale G, Gallo C, et al. Esophageal achalasia in the Veneto region: epidemiology and treatment. Epidemiology and
treatment of achalasia. J Gastrointest Surg 2011;15:423-8.
2. Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC. Five year prospective study of the incidence, clinical features, and diagnosis
of achalasia in Edinburgh. Gut 1992;33:1011-5.
3. O’Neill OM, Johnston BT, Coleman HG. Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J
Gastroenterol 2013;19:5806-12.
4. Podas T, Eaden J, Mayberry M, Mayberry J. Achalasia: a critical review of epidemiological studies. Am J Gastroenterol 1998;93:2345-7.
5. Ho KY, Tay HH, Kang JY. A prospective study of the clinical features, manometric findings, incidence and prevalence of achalasia in
Singapore. J Gastroenterol Hepatol 1999;14:791-5.
6. Farrukh A, DeCaestecker J, Mayberry JF. An epidemiological study of achalasia among the South Asian population of Leicester, 1986-