Improving the surgery for sigmoid achalasia: long-term results of a technical detail☆

Faccani, Enrico; Mattioli, Sandro; Lugaresi, Marialuisa; Simone, Massimo Pierluigi Di; Bartalena, Tommaso; Pilotti, Vladimiro

doi:10.1016/j.ejcts.2007.09.009

Cited by 34 publications

(29 citation statements)

References 24 publications

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“…However, when the lower esophagus is S-shaped, surgical results have frequently been less than satisfactory for symptomatic relief of dysphagia and improvement in esophageal clearance. Although Patti et al [12] reported the response rate of the laparoscopic Heller-Dor method for sigmoid-type achalasia to be 92%, poorer results were reported by Faccani et al [13] (69.7%), Mineo et al [14] (72%), and Palanivelu et al [15] (82%) . Therefore, the response rate for sigmoid-type achalasia is generally lower than that for the non-sigmoid type.…”

Section: Discussionmentioning

confidence: 93%

A case of sigmoid-type achalasia treated with hand-assisted laparoscopic Heller-Dor procedure

et al. 2009

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A male patient in his thirties was referred with dysphagia lasting 8 years. He had a history of a laparotomy for a testicular tumor in his twenties. From an upper gastrointestinal contrast X-ray, he was diagnosed to have sigmoid-type achalasia (greatest transverse diameter, 80 mm). Hand-assisted laparoscopic Heller-Dor surgery was performed because straightening of the esophagus using only a laparoscope was diffi cult due to the marked curvature of the lower mediastinal part of the esophagus and the history of a laparotomy. The postoperative course was excellent; the patient was discharged on day 9. At present, his dysphagia has disappeared and oral intake is satisfactory. Marked improvement was also found on a timed barium esophagogram. In sigmoid-type achalasia, there are limitations to straightening of the lower esophagus, so the improvement of symptoms is frequently insufficient. The present surgical method allows overcoming these diffi culties and is very effective.

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Section: Discussionmentioning

confidence: 93%

A case of sigmoid-type achalasia treated with hand-assisted laparoscopic Heller-Dor procedure

et al. 2009

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“…There are various surgical techniques used according to the situation. Many authors describe very good results after Heller myotomy or balloon dilatation 10,14 . Patti et al.…”

Section: Discussionmentioning

confidence: 99%

“…Many authors describe very good results after Heller myotomy or balloon dilatation. 10,14 Patti et al carried out laparoscopic Heller myotomy on patients with dilatated esophagus with straight-axis configuration and sigmoid-shaped configuration. They reported good relief of dysphagia in 92% of patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic criteria and surgical procedure for megaesophagus - a personal experience

Lewandowski

2009

Diseases of the Esophagus

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Megaesophagus is the end-stage of achalasia cardiae. It is the result of peristaltic disorders and slow decompensation of the muscular layer of the esophagus. The aim of this article is to detail the diagnostic criteria and surgical management of megaesophagus. Criteria were acute bending of esophagus axis; lack of esophagus peristalsis, and no response to stimulation in the manometric test; and Los Angeles C/D esophagitis in the endoscopic examination. Between 1991 and 2004 seven patients (5 females, 2 males; age, 51-67 years; average age, 59 +/- 8 years) were treated. A bypass made from the pedunculated part of the jejunum connecting the part of esophagus above the narrowing with the praepyloric part of the stomach was made. Access was by an abdominal approach. A jejunum bypass was made in six patients with megaesophagus. A transhiatal esophageal resection was carried out, and in the second stage a supplementary esophagus was made from the right half of the colon on the ileocolic vessels in one patient who had experienced two earlier unsuccessful operations. Symptoms of dysphagia, recurrent inflammation of the respiratory tract, and pain subsided in all patients. Complications were not reported in the postoperative period. All patients survived. Subsequent radiographic and endoscopic examination showed very good outcome. The jejunum bypass gave very good results in the surgical treatment of megaesophagus.

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“…Faccani et al reported that the pull-down technique improved the clinical objective and subjective outcomes of LHM + Dor for sigmoid achalasia. 99 LHM + Dor is effective in the presence of sigmoid achalasia, but the clinical result is not as good as for nonsigmoid achalasia. The majority of patients with the most severely dilated esophagus did not require an esophagectomy.…”

Section: Introductionmentioning

confidence: 92%

Surgical treatment for achalasia: when should it be performed, and for which patients?

Kashiwagi

Omura

2011

Gen Thorac Cardiovasc Surg

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Achalasia is a rare motor disorder of the esophagus, characterized by the absence of peristalsis and impaired swallow-induced relaxation. In the past decade, evidence has been accumulated suggesting that achalasia may be an immune-mediated inflammatory disorder. With the advent of minimally invasive surgery, laparoscopic Heller myotomy (LHM) has slowly shifted the treatment of achalasia toward the greater use of surgical therapy. The goal of both surgical and nonsurgical treatment is to eliminate the outflow obstruction afforded by a nonrelaxing sphincter, relieving dysphagia and maintaining a barrier against gastroesophageal reflux (GER). Endoscopic botulinum toxin injection (EBTI) is safe, easy to perform, inexpensive, and effective in aged patients, and it is especially effective when the lower esophageal pressure is hypertonic. This therapeutic option is reserved for patients too ill to undergo any surgical procedure. Pneumatic dilation (PD) has been shown to be an effective and inexpensive treatment with few adverse effects. The long-term success rate of PD seems to drop progressively over time. Heller myotomy (HM) has shown the best clinical efficacy in achalasia as a first-line treatment. Multiple endoscopic treatments are associated with poorer outcomes after HM. EBTI also makes LHM more difficult and results in a worse surgical outcome. The inferior symptomatic outcomes after thoracoscopic HM may be caused by the difficulty in extending an adequate myotomy onto the stomach from the chest and the inability to create a fundoplication. LHM with Dor's fundoplication (LHM + Dor) is effective and is safer procedure for avoiding GER, dysphagia, mucosal perforation, and a pseudodiverticulum. LHM + Dor is also effective in the presence of sigmoid achalasia, but the clinical result is not as good as nonsigmoid achalasia. A few patients need esophagectomy for surgical failure of HM. However, considering the risk of esophagectomy, LHM + Dor is the first treatment option for patients with achalasia regardless of the degree of esophageal dilatation. This procedure is therefore considered to be an effective and safe treatment for patients of any age or with any condition.

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Improving the surgery for sigmoid achalasia: long-term results of a technical detail☆

Abstract: The Heller-Dor operation is effective in the presence of sigmoid achalasia. The clinical objective and subjective evaluations show a trend toward the improvement of results with the pull-down technique. Stronger statistical significance would probably be obtained from a larger case series.

Cited by 34 publications

References 24 publications

A case of sigmoid-type achalasia treated with hand-assisted laparoscopic Heller-Dor procedure

A case of sigmoid-type achalasia treated with hand-assisted laparoscopic Heller-Dor procedure

Diagnostic criteria and surgical procedure for megaesophagus - a personal experience

Surgical treatment for achalasia: when should it be performed, and for which patients?

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