Laparoscopic Heller Cardiomyotomy and Dor Fundoplication for Esophageal Achalasia

Pechlivanides, George

doi:10.1001/archsurg.136.11.1240

Cited by 54 publications

(41 citation statements)

References 18 publications

(48 reference statements)

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“…There were five studies [24][25][26][27][28] and three studies [29][30][31] that assessed the efficacy of HM for failed PD as the firstline treatment. The remission rate was 77.8%-93%.…”

Section: Study Characteristicsmentioning

confidence: 99%

Recurrent achalasia treated with Heller myotomy: A review of the literature

Wang¹,

Li²

2008

WJG

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AIM:To evaluate the efficacy and safety of Heller myotomy (HM) for recurrent achalasia, performed after different methods of first-line treatment. METHODS:We searched for studies published in PubMed from 1966 to March 2008 on treatment of recurrent achalasia with HM after failure with different methods of first-line treatment. The efficacy of HM was assessed by a pooled estimate of response rate with individual studies weighted proportionally to sample size. RESULTS: Sixteen studies were eligible and included in the review. The results showed that HM has a better remission rate for recurrent achalasia after failure of HM [weighted mean (SD)] of 86.9% (21.8%) compared with 81.6% (23.8%) for pneumatic dilatation (PD). One study evaluated the efficacy of HM after failure of PD combined with botulinum toxin injection (83%). The most common complications were perforation and gastroesophageal reflux. CONCLUSION: HM has the best efficacy in patients with recurrent achalasia who were treated with HM as first-line treatment. Future studies should focus on how to increase the success rate and decrease the complications of HM.

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“…There were five studies [24][25][26][27][28] and three studies [29][30][31] that assessed the efficacy of HM for failed PD as the firstline treatment. The remission rate was 77.8%-93%.…”

Section: Study Characteristicsmentioning

confidence: 99%

Recurrent achalasia treated with Heller myotomy: A review of the literature

Wang¹,

Li²

2008

WJG

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“…Previous reports have shown good long-term results of LHD for esophageal achalasia: percent relief of dysphagia of up to 90% [12,13,14]. Our present study evaluated the long-term clinical and functional effectiveness of LHD, which also seemed to ensure a comparable or even better control of dysphagia: 95% of treated patients improved their preoperative symptoms.…”

Section: Discussionmentioning

confidence: 74%

“…This indicated that the stasis of the food in the esophagus was improved, which was closely correlated with the symptom of dysphagia. Pechlivanides et al [13] reported that total relief of symptoms occurred only when the postoperative esophageal diameter was less than 40 mm. Our results show that all cases, except one that had a widely spread sigmoid-type achalasia, were within this range after surgery.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Heller-Dor Surgery for Esophageal Achalasia: Impact of Intraoperative Real-Time Manometric Feedback on Postoperative Outcomes

Endo

Nakajima²,

Nishikawa³

et al. 2009

Dig Surg

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Background: Laparoscopic Heller myotomy with Dor fundoplication (LHD) is one of the most established surgical procedures for esophageal achalasia. Preoperative esophageal manometry has been reported as useful to evaluate lower esophageal sphincter (LES) pressure. However, the feasibility, safety, and impact of its intraoperative use have not been fully evaluated, especially when enhanced with real-time 3-D pressure imaging. Methods: LHD was attempted on 24 consecutive patients with esophageal achalasia. Manometry was performed at 3 time points during LHD: before myotomy, after myotomy, and after fundoplication. Investigations included esophagography, manometry, and 24-hour esophageal pH monitoring in the preoperative, short-term (0–5 months) and long-term (1–3 years) follow-up periods. Results: The 3-D intraoperative manometric images were presented to the surgical crew on a monitor screen immediately after each measurement in all attempted cases (n = 13). Any residual high pressure zone of the LES was easily recognized and resolved with additional myotomy. Postoperative esophagographies showed resolution of esophageal dilatation. Manometric examination revealed significant reduction of LES pressure in the short-/long-term follow-up periods. PH monitoring showed no increase in acid reflux. Overall outcomes were satisfactory (symptom relief = 95%). Conclusion: Intraoperative manometry with real-time pressure feedback is a feasible, safe, and useful adjunct in LHD.

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“…The longest times were documented for patients with mucosal perforation; in these cases, oral intake was intentionally resumed 1 week after the operation. The median hospital stay was 4 days (range, [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

Section: Resultsmentioning

confidence: 99%

“…Four intraoperative complications occurred-two mucosal perforations that were resolved laparoscopically and two cases of pneumothorax. The median hospital stay was 4 days (range, [2][3][4][5][6][7][8][9][10][11][12][13][14] and the median time to start oral feeding was 3 days (range, [1][2][3][4][5][6][7]. After a median follow-up of 14 months (range, 2-83), 16 patients were asymptomatic and four had mild heartburn and/or dysphagia.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Heller myotomy for classic achalasia: results of our initial series of 20 patients

et al. 2005

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Laparoscopic Heller Cardiomyotomy and Dor Fundoplication for Esophageal Achalasia

Abstract: Hypothesis: Laparoscopic Heller myotomy with anterior hemifundoplication is the surgical procedure of choice for the treatment of esophageal achalasia. Specific factors, eg, severity of esophageal body deformity, might affect postoperative outcome.

Cited by 54 publications

References 18 publications

Recurrent achalasia treated with Heller myotomy: A review of the literature

Recurrent achalasia treated with Heller myotomy: A review of the literature

Laparoscopic Heller-Dor Surgery for Esophageal Achalasia: Impact of Intraoperative Real-Time Manometric Feedback on Postoperative Outcomes

Laparoscopic Heller myotomy for classic achalasia: results of our initial series of 20 patients

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