Significance of Limited Hiatal Dissection in Surgery for Achalasia

Simić, Aleksandar; Radovanović, Nebojša; Skrobić, Ognjan; Raznatovic, Zoran; Peško, P

doi:10.1007/s11605-009-1135-9

Cited by 51 publications

(24 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Simic et al [23] found that Dor fundoplication in the setting of a complete hiatal dissection had a higher degree of abnormal esophageal acid exposure (23.1%) than if a limited hiatal dissection was performed (8.5%). In another study [24] with 1-and 5-year follow-up, 21% of patients exhibited abnormal acid exposure on pH testing, but 66% of those reflux events were thought to be from lactic acid production secondary to stagnation and food stasis in the distal esophagus.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial

Soper²,

et al. 2011

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial

Soper²,

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Some have argued that not repairing the hiatus may lead to a higher rate of reflux, which may exacerbate postoperative recurrence of dysphagia [99]. Others have argued that the dissection of the hiatus should be limited by leaving the lateral and posterior phrenoesophageal attachments intact, as this measure minimizes postoperative reflux independent of the addition of a Dor fundoplication [100]. Unfortunately, there are no high-quality studies that address this issue, but it appears plausible that the hiatus should be approximated when necessary, emphasizing that it not be made too tight.…”

Section: Hiatal Dissection and Hiatus Hernia Repair During Myotomymentioning

confidence: 99%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

View full text Add to dashboard Cite

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...

show abstract

“…All of our experiences in open surgery for achalasia, including the method of limited hiatal dissection which we have proven in randomized trial to be influential in postoperative gastroesophageal reflux (GER) prevention, we transferred in laparoscopic surgery [19]. As concerning the intra or postoperative complications, in patients operated laparoscopically due to achalasia we had no conversions to open procedure, but one patient was reoperated due to port side bleeding.…”

Section: Discussionmentioning

confidence: 99%