The Outcome of Laparoscopic Heller Myotomy for Achalasia is Not Influenced by the Degree of Esophageal Dilatation
In the past, a Heller myotomy was considered to be ineffective in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus. Esophagectomy was the standard treatment. The aims of this study were (a) to evaluate the results of laparoscopic Heller myotomy and Dor fundoplication in pat...
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| Veröffentlicht in: | Journal of gastrointestinal surgery 2008, Vol.12 (1), p.159-165 |
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| creator | Sweet, Matthew P. Nipomnick, Ian Gasper, Warren J. Bagatelos, Karen Ostroff, James W. Fisichella, Piero M. Way, Lawrence W. Patti, Marco G. |
| description | In the past, a Heller myotomy was considered to be ineffective in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus. Esophagectomy was the standard treatment. The aims of this study were (a) to evaluate the results of laparoscopic Heller myotomy and Dor fundoplication in patients with achalasia and various degrees of esophageal dilatation; and (b) to assess the role of endoscopic dilatation in patients with postoperative dysphagia. One hundred and thirteen patients with esophageal achalasia were separated into four groups based on the maximal diameter of the esophageal lumen and the shape of the esophagus: group A, diameter 6.0 cm and straight axis, 23 patients; and group D, diameter >6.0 cm and sigmoid-shaped esophagus, 12 patients. All had a laparoscopic Heller myotomy and Dor fundoplication. The median length of follow-up was 45 months (range 7 months to 12.5 years). The postoperative recovery was similar among the four groups. Twenty-three patients (20%) had postoperative dilatations for dysphagia, and five patients (4%) required a second myotomy. Excellent or good results were obtained in 89% of group A and 91% of groups B, C, and D. None required an esophagectomy to maintain clinically adequate swallowing. These data show that (a) a laparoscopic Heller myotomy relieved dysphagia in most patients with achalasia, even when the esophagus was dilated; (b) about 20% of patients required additional treatment; (c) in the end, swallowing was good in 90%. |
| doi_str_mv | 10.1007/s11605-007-0275-z |
| format | Article |
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Esophagectomy was the standard treatment. The aims of this study were (a) to evaluate the results of laparoscopic Heller myotomy and Dor fundoplication in patients with achalasia and various degrees of esophageal dilatation; and (b) to assess the role of endoscopic dilatation in patients with postoperative dysphagia. One hundred and thirteen patients with esophageal achalasia were separated into four groups based on the maximal diameter of the esophageal lumen and the shape of the esophagus: group A, diameter <4.0 cm, 46 patients; group B, esophageal diameter 4.0–6.0 cm, 32 patients; group C, diameter >6.0 cm and straight axis, 23 patients; and group D, diameter >6.0 cm and sigmoid-shaped esophagus, 12 patients. All had a laparoscopic Heller myotomy and Dor fundoplication. The median length of follow-up was 45 months (range 7 months to 12.5 years). The postoperative recovery was similar among the four groups. Twenty-three patients (20%) had postoperative dilatations for dysphagia, and five patients (4%) required a second myotomy. Excellent or good results were obtained in 89% of group A and 91% of groups B, C, and D. None required an esophagectomy to maintain clinically adequate swallowing. These data show that (a) a laparoscopic Heller myotomy relieved dysphagia in most patients with achalasia, even when the esophagus was dilated; (b) about 20% of patients required additional treatment; (c) in the end, swallowing was good in 90%.</description><identifier>ISSN: 1091-255X</identifier><identifier>EISSN: 1873-4626</identifier><identifier>DOI: 10.1007/s11605-007-0275-z</identifier><identifier>PMID: 17710504</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Deglutition - physiology ; Deglutition Disorders - etiology ; Deglutition Disorders - therapy ; Dilatation, Pathologic ; Dysphagia ; Esophageal Achalasia - pathology ; Esophageal Achalasia - physiopathology ; Esophageal Achalasia - surgery ; Esophagus - pathology ; Esophagus - physiopathology ; Esophagus - surgery ; Female ; Follow-Up Studies ; Fundoplication - methods ; Gastroenterology ; Humans ; Laparoscopy - methods ; Male ; Manometry ; Medicine ; Medicine & Public Health ; Middle Aged ; Muscle, Smooth - surgery ; Postoperative Complications ; Pressure ; Retrospective Studies ; Severity of Illness Index ; Surgery ; Time Factors ; Treatment Outcome</subject><ispartof>Journal of gastrointestinal surgery, 2008, Vol.12 (1), p.159-165</ispartof><rights>The Society for Surgery of the Alimentary Tract 2007</rights><rights>The Society for Surgery of the Alimentary Tract 2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c370t-7684b10c396cdebbf3e2ede43ef29b19575c12554d84f7aeaba3eac94c9f55df3</citedby><cites>FETCH-LOGICAL-c370t-7684b10c396cdebbf3e2ede43ef29b19575c12554d84f7aeaba3eac94c9f55df3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11605-007-0275-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11605-007-0275-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/17710504$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sweet, Matthew P.</creatorcontrib><creatorcontrib>Nipomnick, Ian</creatorcontrib><creatorcontrib>Gasper, Warren J.</creatorcontrib><creatorcontrib>Bagatelos, Karen</creatorcontrib><creatorcontrib>Ostroff, James W.</creatorcontrib><creatorcontrib>Fisichella, Piero M.</creatorcontrib><creatorcontrib>Way, Lawrence W.</creatorcontrib><creatorcontrib>Patti, Marco G.</creatorcontrib><title>The Outcome of Laparoscopic Heller Myotomy for Achalasia is Not Influenced by the Degree of Esophageal Dilatation</title><title>Journal of gastrointestinal surgery</title><addtitle>J Gastrointest Surg</addtitle><addtitle>J Gastrointest Surg</addtitle><description>In the past, a Heller myotomy was considered to be ineffective in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus. Esophagectomy was the standard treatment. The aims of this study were (a) to evaluate the results of laparoscopic Heller myotomy and Dor fundoplication in patients with achalasia and various degrees of esophageal dilatation; and (b) to assess the role of endoscopic dilatation in patients with postoperative dysphagia. One hundred and thirteen patients with esophageal achalasia were separated into four groups based on the maximal diameter of the esophageal lumen and the shape of the esophagus: group A, diameter <4.0 cm, 46 patients; group B, esophageal diameter 4.0–6.0 cm, 32 patients; group C, diameter >6.0 cm and straight axis, 23 patients; and group D, diameter >6.0 cm and sigmoid-shaped esophagus, 12 patients. All had a laparoscopic Heller myotomy and Dor fundoplication. The median length of follow-up was 45 months (range 7 months to 12.5 years). The postoperative recovery was similar among the four groups. Twenty-three patients (20%) had postoperative dilatations for dysphagia, and five patients (4%) required a second myotomy. Excellent or good results were obtained in 89% of group A and 91% of groups B, C, and D. None required an esophagectomy to maintain clinically adequate swallowing. 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Esophagectomy was the standard treatment. The aims of this study were (a) to evaluate the results of laparoscopic Heller myotomy and Dor fundoplication in patients with achalasia and various degrees of esophageal dilatation; and (b) to assess the role of endoscopic dilatation in patients with postoperative dysphagia. One hundred and thirteen patients with esophageal achalasia were separated into four groups based on the maximal diameter of the esophageal lumen and the shape of the esophagus: group A, diameter <4.0 cm, 46 patients; group B, esophageal diameter 4.0–6.0 cm, 32 patients; group C, diameter >6.0 cm and straight axis, 23 patients; and group D, diameter >6.0 cm and sigmoid-shaped esophagus, 12 patients. All had a laparoscopic Heller myotomy and Dor fundoplication. The median length of follow-up was 45 months (range 7 months to 12.5 years). The postoperative recovery was similar among the four groups. Twenty-three patients (20%) had postoperative dilatations for dysphagia, and five patients (4%) required a second myotomy. Excellent or good results were obtained in 89% of group A and 91% of groups B, C, and D. None required an esophagectomy to maintain clinically adequate swallowing. These data show that (a) a laparoscopic Heller myotomy relieved dysphagia in most patients with achalasia, even when the esophagus was dilated; (b) about 20% of patients required additional treatment; (c) in the end, swallowing was good in 90%.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>17710504</pmid><doi>10.1007/s11605-007-0275-z</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Deglutition - physiology Deglutition Disorders - etiology Deglutition Disorders - therapy Dilatation, Pathologic Dysphagia Esophageal Achalasia - pathology Esophageal Achalasia - physiopathology Esophageal Achalasia - surgery Esophagus - pathology Esophagus - physiopathology Esophagus - surgery Female Follow-Up Studies Fundoplication - methods Gastroenterology Humans Laparoscopy - methods Male Manometry Medicine Medicine & Public Health Middle Aged Muscle, Smooth - surgery Postoperative Complications Pressure Retrospective Studies Severity of Illness Index Surgery Time Factors Treatment Outcome |
| title | The Outcome of Laparoscopic Heller Myotomy for Achalasia is Not Influenced by the Degree of Esophageal Dilatation |
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