Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum

Fraiji, Elie; Bloomston, Mark; Carey, Larry C.; Zervos, Emmanuel E.; Goldin, Steven B.; Banasiak, Magdalena; Wallace, Mary Elizabeth; Rosemurgy, Alexander S.

doi:10.1007/s00464-002-8959-7

Cited by 44 publications

(25 citation statements)

References 11 publications

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“…Intraoperative endoscopy is recommended by many experts, because it may be useful in guiding the completeness of the myotomy and the diverticulectomy, preventing esophageal narrowing, and detecting leaks intraoperatively [126].…”

Section: Epiphrenic Diverticulamentioning

confidence: 99%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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PreambleThe guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive techniques for the treatment of achalasia in specific clinical circumstances. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used to treat this condition. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth. DisclaimerClinical practice guidelines are intended to indicate the best available approach to medical conditions as established by a systematic review of available data and expert opinion. The approach suggested may not necessarily be the only acceptable approach given the complexity of the healthcare environment. These guidelines are intended to be flexible, because the surgeon must always choose the approach best suited to the individual patient and variables in existence at the moment of decision. These guidelines are applicable to all physicians who are appropriately credentialed and address the clinical situation in question, regardless of specialty.Guidelines are developed under the auspices of SAGES-the guidelines committee-and are approved by the Board of Governors. The recommendations of each guideline undergo multidisciplinary review and are considered valid at the time of production based on the data available. New developments in medical research and practice pertinent to each guideline are reviewed, and guidelines will be periodically updated. Literature review methodA systematic literature search was performed on MED-LINE in October 2010. The search strategy was limited to adult English language articles and is shown in Fig. 1.We identified 214 relevant articles. The abstracts were reviewed by four committee members (DS, WR, TMF, and GPK) and divided into the following categories:(a) Randomized studies, meta-analyses, and systematic reviews and Other Interventional Techniques (b) Prospective studies (c) Retrospective studies (d) Case reports (e) Review articlesRandomized controlled trials, meta-analyses, and systematic reviews were selected for further review along with prospective and retrospective studies that included at least 50 patients. Studies with smaller samples were considered when additional evidence was lacking. The most recent reviews also were included. All case reports, old reviews, and smaller studies were excluded. According to these exclusion criteria, 102 articles were selected for review. Whenever the available evidence from Level I studies was considered to be adequate, lower evidence level studies were not considered.The reviewers graded the level of evidence and manually searched the bibliography of each article for additional articl...

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Section: Epiphrenic Diverticulamentioning

confidence: 99%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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“…Esophageal damage was the only complication observed in one of the reported cases. 7,8,[19][20][21][22][23] There appear to be no reports of the performance of the same technique so a comparison cannot be made, but the postoperative course of the present patient has been very good, thus indicating this technique to be effective.…”

Section: Discussionmentioning

confidence: 64%

Laparoscopic heller myotomy and dor fundoplication combined with laparoscopic diverticular introversion suturing for achalasia complicated by epiphrenic diverticulum: Report of a case

et al. 2010

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A 41-year-old woman was admitted due to dysphagia and weight loss of 6 kg. An upper gastrointestinal radiographic contrast study demonstrated an S-shaped lower esophagus with a peak transverse diameter of 65 mm. Moreover, an epiphrenic diverticulum was also detected in the lower part of the esophagus (50 x 40 mm). The measurement of intraesophageal pressure showed a lower esophageal sphincter pressure of 80 mmHg and a lower esophageal sphincter length of 31 mm. Esophageal clearance assessment via a timed barium esophagogram demonstrated impaired contrast clearance, with a rate of 26% at 5 min. A laparoscopic Heller myotomy, Dor fundoplication, and diverticular introversion suturing were performed. The postoperative course was uneventful and the patient was discharged on day 4. At the 2-year follow-up, no dysphagia was present. This is the first report of a laparoscopic diverticuloplasty using an introversion buried suture with a Heller myotomy and Dor fundoplication for achalasia complicated by an epiphrenic diverticulum.

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“…Another disease commonly associated with esophageal motility disorders such as achalasia is epiphrenic diverticulum [13,20]. This disease is easily diagnosed using barium contrast and upper endoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…These include unusual upper GE conditions such as epiphrenic diverticulum [13], hiatal hernia [8,9,14], and pseudoachalasia [5][6][7]. This report aims to evaluate the incidence of GE illnesses associated with achalasia and their impact on laparoscopic surgery for achalasia.…”

Section: Introductionmentioning

confidence: 99%

Unusual upper gastrointestinal diseases associated with achalasia: laparoscopic approach

Berindoague¹,

Targarona²,

Palá

et al. 2007

Surg Endosc

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Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum

Abstract: Laparoscopic esophageal diverticulectomy, Heller myotomy, and partial fundoplication with intraoperative endoscopy safely reduce dysphagia associated with achalasia and esophageal diverticula while limiting symptoms of gastroesophageal reflux.

Cited by 44 publications

References 11 publications

SAGES guidelines for the surgical treatment of esophageal achalasia

SAGES guidelines for the surgical treatment of esophageal achalasia

Laparoscopic heller myotomy and dor fundoplication combined with laparoscopic diverticular introversion suturing for achalasia complicated by epiphrenic diverticulum: Report of a case

Unusual upper gastrointestinal diseases associated with achalasia: laparoscopic approach

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