Objective: To describe the technique employed and our experience with primary laparoscopic repair
of distal esophageal perforations produced during laparoscopic esophagomyotomy, as well as
to evaluate the outcomes.
Materials and Methods: We analyzed six cases of patients with primary achalasia in whom distal
esophageal mucosal perforations were caused during laparoscopic esophagomyotomy. A primary
repair and fundoplication was performed in five cases; in the sixth patient, the perforation could
not be recognized during the surgical procedure. The postoperative follow-up included clinical evaluation,
upper gastrointestinal endoscopy, esophageal manometry, and ambulatory 24-h esophageal
pH monitoring.
Results: Five patients reported dysphagia relief and were highly satisfied with the final surgical
outcome. In one case we observed an altered postoperative 24-h esophageal pH. Two patients developed
esophageal leakage, one with a fatal outcome.
Conclusion: The primary repair of distal esophageal perforations during laparoscopic
esophagomyotomy is a valid therapeutic option and does not alter the surgical purpose. However,
if the perforation is not recognized early on, the prognosis can change.
