Gastroesophageal reflux, quality of life, and satisfaction in patients with achalasia treated with open cardiomyotomy and partial fundoplication

Ponce, Marta; Ortiz, Vicente; Juan, Maria Rosa Gil; Garrigues, Vicente; Castellanos, Concepción; Ponce, Julio

doi:10.1016/s0002-9610(03)00076-x

Cited by 28 publications

(27 citation statements)

References 21 publications

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“…However, in this series, no preoperative data were available for pre-to postoperative comparisons. These results were analogous with those obtained by Ponce et al [17] in 28 Spanish-speaking patients who underwent open Heller myotomy plus Dor fundoplication. Katilius et al [23] studied 15 patients after laparoscopic and eight after laparotomy myotomy.…”

Section: Discussionsupporting

confidence: 91%

“…The automatic relationship between myotomy and reflux has been recently denied by Sharp et al [16] are now conducting a randomized trial to compare the effective need for a Dor fundoplication with a Heller myotomy. On the contrary, Ponce et al [17] found a relatively frequent presence of reflux despite open myotomy and Dor fundoplication. Falkenback et al [18], in a recent prospective randomized study compared results with and without floppy Nissen fundoplication and found a significantly lower 24-h reflux in the latter group without adding dysphagia.…”

Section: Discussionmentioning

confidence: 93%

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Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

Mineo

Ambrogi

2004

European Journal of Cardio-Thoracic Surgery

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Objective: To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia. Methods: Thirty-nine patients with achalasia (25 males, mean age 42^13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1 ¼ no symptoms; 4 ¼ persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30^34 mmHg. Six patients had undergone previous pneumatodilation. Results: No procedure related mortality was recorded. Mean follow-up was 107^30 months (54 -177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3^8.3 mmHg ðP , 0:001Þ; in oesophageal width was 11.5^7.1 mm ðP , 0:001Þ; in dysphagia 1.8^0.8 ðP , 0:01Þ and regurgitation 1.4^0.7 ðP , 0:01Þ: Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement ðP , 0:001Þ especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure. Conclusion: Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia. q

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 93%

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

Mineo

Ambrogi

2004

European Journal of Cardio-Thoracic Surgery

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“…In particular, heartburn may be confused with regurgitation or substernal pain, while presence of excessive acid in the esophageal lumen may not produce heartburn at all, due to decreased mechanosensitivity and chemosensitivity caused by achalasia [20]. In general, GER symptoms seem not to be related to increased esophageal acid exposure [21][22][23]. Gholoum et al [9] have shown that moderate or severe heartburn after myotomy and fundoplication is associated with a pathologic esophageal acid exposure in at least half of the patients, while a significant proportion of patients, ranging between 7 and 23 percent, may have ''silent reflux'', namely absence of heartburn but increased esophageal acid exposure.…”

Section: Discussionmentioning

confidence: 99%

Patterns of esophageal acid exposure after laparoscopic Heller’s myotomy and Dor’s fundoplication for esophageal achalasia

et al. 2007

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“…There is a debate with regard to the need for additional fundoplication in open myotomy. In some studies, gastroesophageal reflux was relatively frequent even after combining myotomy with anti-reflux procedures [47,48] . There is increasing experience with Heller myotomy performed by minimally invasive techniques (laparoscopy or thoracoscopy), and these techniques have become the procedure of choice by many experienced surgeons for uncomplicated cases in Western countries.…”

Section: Surgical Myotomymentioning

confidence: 99%

Achalasia: A review of Western and Iranian experiences

Mikaeli¹,

Islami²,

Malekzadeh³

2009

WJG

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Achalasia is a primary motor disorder of the eso phagus, in which esophageal emptying is impaired. Diagnosis of achalasia is based on clinical findings. The diagnosis is confirmed by radiographic, endoscopic, and manometric evaluations. Several treatments for achalasia have been introduced. We searched the PubMed Database for original articles and meta analyses about achalasia to summarize the current knowledge regarding this disease, with particular focus on different procedures that are used for treatment of achalasia. We also report the Iranian experience of treatment of this disease, since it could be considered as a model for mediumresource countries. Myotomy, particularly laparoscopic myotomy with fundoplication, i s t h e m o s t e ffe c t i ve t re a t m e n t fo r a c h a l a s i a . Compared to other treatments, however, the initial cost of myotomy is usually higher and the recovery period is longer. When performing myotomy is not indicated or not possible, graded pneumatic dilation with slow rate of balloon inflation seems to be an effective and safe initial alternative. Injection of botulinum toxin into the lower esophageal sphincter before pneumatic dilation may increase remission rates. However, this needs to be confirmed in further studies. Due to lack of adequate information regarding the role of expandable stents in the treatment of achalasia, insertion of stents does not currently seem to be a recommended treatment. In summary, laparoscopic myotomy can be considered as the procedure of choice for treatment of achalasia. Graded pneumatic dilation is an effective alternative when the performance of myotomy is not possible for any reason.

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Gastroesophageal reflux, quality of life, and satisfaction in patients with achalasia treated with open cardiomyotomy and partial fundoplication

Cited by 28 publications

References 21 publications

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

Patterns of esophageal acid exposure after laparoscopic Heller’s myotomy and Dor’s fundoplication for esophageal achalasia

Achalasia: A review of Western and Iranian experiences

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