Background: Achalasia is an esophageal motor disorder characterized by increased lower esophageal sphincter (LES) pressure and diminished or absent peristalsis in the distal esophagus. This trial assessed the functional Outcome of laparoscopic Heller cardiomyotomy in treatment of patients with achalasia of the cardia using the Eckardt score. Methods: This prospective randomized trial included 30 patients with Achalasia of the cardia. These patients were managed at Banha and Mansoura University Hospitals by doing laparoscopic Heller cardiomyotomy. Follow-up was planned for 6 months for Eckardt score. Results: There was a statistically significant decrease in Eckardt score in all patients who done laparoscopic Heller cardiomyotomy (P<0.001) and 7% of patients (2 patients) had esophageal perforation and management done intraoperative with good improvement in the follow up. Conclusions: According to presented evidence, laparoscopic myotomy with anti-reflux procedures is the optimal first-line treatment for achalasia with a satisfactory improvement in quality of life.
Background: Despite the positive effect of sleeve gastrectomy regarding weight loss and improvement in obesity co-morbidities, there are concerns about its effect on esophageal motility especially the effect on lower esophageal sphincter function and the development of de novo GERD or worsening the existing GERD after this bariatric operation. Aims of the study is to compare preoperative with postoperative oesophageal manometric studies in patients undergoing sleeve gastrectomy; and study the consequences as well as the preoperative oesophageal motility disorders that might affect the outcome of sleeve gastrectomy in morbidly obese patients. Methodology: This is a prospective study for patients with morbid
Nowadays, wide range of population experience proctologic pathologies at least once in their lives. 10-15% of proctologic pathologies patients suffer from anal fissure that impair their usual life. So it is mandatory to know how to achieve effective treatment for anal fissure. Aim of Study: The aim of this study is to establish any predictive value of anorectal manometry in assessing the effectiveness of anal fissure treatment.Patients and Methods: This is a prospective study done on 30 patients recruited from outpatient clinic in Benha University divided into two groups whereas group (A) included 15 patients with acute anal fissure (less than six weeks from onset of disease), and group (B) included 15 patients with chronic anal fissure (more than six weeks from onset of disease). Anomanometry was done for all patients and the results were compared.Results: patients with acute anal fissure showed normotensive anal resting pressure (Mean±SD 50.8 ± 5.76 mmHg in males and 64.4 ± 5.81 mmHg in females), while those with chronic anal fissure showed high resting pressure (Mean±SD 88.3 ± 6.18 mmHg in females and 88.65±1.05 mmHg in males).Conclusion: we can conclude that acute anal fissure disease is not usually associated with elevated resting anal pressure but chronic anal fissure is usually associated with hypertensive anal resting pressure in majority of patients. These manometric findings may explain why most cases of acute case anal fissure can be treated medically while cases with chronic anal fissure usually need surgical intervention that liberates anal pressure from hypertensive state to normotensive state. We also can predict that patients with chronic anal fissure associated with normotensive resting anal pressure may be treated either medically or surgically without doing internal sphincterotomy.
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