Minimally Invasive Surgery for Achalasia

Patti, Marco G.; Pellegrini, Carlos A.; Horgan, Santiago; Arcerito, Massimo; Omelanczuk, Pablo; Tamburini, A.; Diener, Urs; Eubanks, Thomas R.; Way, Lawrence W.

doi:10.1097/00000658-199910000-00014

Cited by 348 publications

(35 citation statements)

References 8 publications

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“…One trial [25] assessed the efficacy of different endoscopic myotomy in achalasia patients. One-year remission rate of patients was 89% in laparoscopic myotomy and 73% in thoracoscopic (P = 0.1).…”

Section: Laparoscopic Myotomy Versus Thoracoscopic Myotomymentioning

confidence: 99%

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Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang

2008

Dig Dis Sci

131

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Pharmacological therapy, botulinum toxin injection, pneumatic dilatation, and surgical myotomy are the primary therapeutic modalities for achalasia, for which laparoscopic myotomy is recommended as state-of-the-art therapy. However, its efficacy and safety remain unclear compared with other approaches in the treatment of achalasia. We searched electronic databases (MEDLINE, EMBASE, Cochrane Central Registry of Controlled Trials, LILACS-Latin American, Caribbean health science literature, and Science Citation Index Expanded) for randomized controlled trials to evaluate which therapeutic measures are temporary and reversible and which measures are definitive and effective by pooling data including remission rate, relapse rate, complications, and adverse effects. Seventeen studies with 761 patients met our inclusion criteria. There was better remission rate in pneumatic dilation than in botulinum toxin injection for initial intervention [relative risk (RR) 2.20, 95% confidence interval (CI) 1.51-3.20], Pneumatic dilation had lower relapse rate than did botulinum toxin injection (RR 0.12, 95% CI 0.04-0.32). Compared with pneumatic dilation, laparoscopic myotomy further increased remission rate (RR 1.48, 95% CI 1.48-1.87), and reduced clinical relapse rate (RR 0.14, 95% CI 0.04-0.58), and there was no difference in complication rate (RR 1.48, 95% CI 0.37-5.99). Based on limited randomized and controlled trials, laparoscopic myotomy is the preferred method for patients with achalasia. Future trials should investigate whether laparoscopic myotomy combined with different modalities of fundoplication is superior to isolated laparoscopic myotomy.

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Section: Laparoscopic Myotomy Versus Thoracoscopic Myotomymentioning

confidence: 99%

“…The most severe complication with pneumatic dilation is perforation. One study reported a higher complication rate of GER after thoracoscopic myotomy (21/35 patients, 67%) than after laparoscopic myotomy (23/133, 17%; P \ 0.03) [25].…”

Section: Complications and Adverse Eventsmentioning

confidence: 99%

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

Wang

2008

Dig Dis Sci

131

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“…These rates were apparently higher than those seen in previous reports: 6.7–17% of postoperative patients [14,15,16]. Tatum et al [7] mentioned that patients with achalasia might be less sensitive to significant gastroesophageal reflux than the general population.…”

Section: Discussionmentioning

confidence: 69%

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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“…19 Publications on failure of laparoscopic myotomy and the need for reoperation include fewer patient numbers and shorter follow-up, if reported at all. [26][27][28]30,32,[34][35][36] One of the two largest series on laparoscopic reoperation reported on by Iqbal et al comprised 11 patients with achalasia 3 (others included had hypertensive lower esophageal sphincter and one had DES) and showed an overall symptom resolution of 40-89%. 30 In this study, the interval between the first and the second operation was rather short with a mean of 23 (3-52) months and a mean follow-up of 30 months.…”

Section: Methodsmentioning

confidence: 99%