Surgery for achalasia: 1998

Shiino, Yutaka; Filipi, Charles J.; Awad, Ziad T.; Tomonaga, Tetsuya; Marsh, Robert E.

doi:10.1016/s1091-255x(99)80096-1

Cited by 25 publications

(22 citation statements)

References 42 publications

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“…An early review of 18 articles involving the minimally invasive techniques concluded that anti-reflux surgery portended a better outcome. 70 In contrast to this, a meta-analysis was published in 2003 and included analysis of 21 studies involving 601 patients and concluded that the rates of postoperative GER were not statistically different between those with and without an antireflux procedure. 71 In fact, PPI use among those that undergo fundoplication with the Heller myotomy is 39%.…”

Section: 68mentioning

confidence: 99%

“…Operative complications including mucosal tearing, perforation or post-operative leakage occur in <10% and surgically related death is extremely rare. 64,70,72,73 Surgical therapy after failed pneumatic dilatation has also been shown to be safe and effective although more difficult. 28,75 New technology involving computer-enhanced robotic surgery may further minimize the surgical morbidity.…”

Section: 68mentioning

confidence: 99%

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Review article: the management of achalasia – a comparison of different treatment modalities¹

Lake¹,

Wong²

2006

Aliment Pharmacol Ther

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SUMMARY BackgroundAchalasia is an uncommon primary oesophageal motor disorder with an unknown aetiology. Therapeutic options for achalasia are aimed at decreasing the lower oesophageal sphincter pressure, improving the oesophageal empting, and most importantly, relieving the symptoms of achalasia. Modalities for treatment include pharmacologic, endoscopic, pneumatic dilatation and surgical. The decision of which modality to use involves the consideration of multiple clinical and economic factors.

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Section: 68mentioning

confidence: 99%

Section: 68mentioning

confidence: 99%

Review article: the management of achalasia – a comparison of different treatment modalities¹

Lake¹,

Wong²

2006

Aliment Pharmacol Ther

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“…The thoracoscopic approach is associated with both an increase in persistent dysphagia and a higher prevalence of GERD (table 3). In addition, two recent comprehensive summaries of the thoracoscopic technique by Vaezi and Richter [26] and Shiino et al [27] respectively reported persistent dysphagia in 115% of patients and secondary GERD in 50%.…”

Section: Surgical Therapymentioning

confidence: 99%

“…At this time there exists no robust data to provide a definitive answer since there are no randomized prospective data available on either topic. In general, surgeons have concluded that inadequate division of the muscle wall results in postoperative dysphagia, while an excessively long myotomy (12 cm beyond the GE junction) may result in GERD [27]. The proponents of not performing a fundoplication argue that the surgeon can achieve an adequate cardiomyotomy without causing reflux, and that adding an antireflux procedure causes resistance to the flow of food, thereby reducing the effectiveness of the myotomy.…”

Section: Necessity and Type Of Antireflux Proceduresmentioning

confidence: 99%

Surgical Treatment of Achalasia: Current Status and Controversies

et al. 2004

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Objective: To review the current management of achalasia, and the controversies regarding the different treatment options. Methods: A review of the literature was performed. The key words used were esophageal achalasia, Heller myotomy, endoscopic balloon dilatation, laparoscopic Heller myotomy, and fundoplication. Results: Patients who fail medical therapy (e.g. pharmacologic therapy, botulinum toxin, balloon dilatation) should be considered for surgical therapy for the management of achalasia. Currently, numerous surgical procedures exist for the treatment of achalasia (transabdominal cardiomyotomy, thoracoscopic or open transthoracic cardiomyotomy, and laparoscopic Heller myotomy with an antireflux procedure). Conclusions: Laparoscopic Heller myotomy is generally accepted as the operative procedure of choice for achalasia. However, controversy exists as to whether a concomitant antireflux procedure is necessary, and if so, what type should be performed. Given the deleterious effects of postoperative reflux, and the facility of including an antireflux procedure at the time of the myotomy, there is merit in undertaking an antireflux procedure at the time of the laparoscopic Heller myotomy.

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“…recent experience has confirmed that the laparoscopic approach is superior to the thoracoscopic, with decreased rates of persistent dysphagia and postoperative GEr (22,23). The optimal length of the distal esophageal myotomy should be 6-7 cm, added by a fundic myotomy of about 2 cm.…”

Section: Laparoscopic Myotomymentioning

confidence: 99%

Impact of Minimally Invasive Surgery in the Spectrum of Current Achalasia Treatment Options

Gockel¹,

Sgourakis²,

Drescher³

et al. 2011

Scand J Surg

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minimally invasive heller myotomy has evolved the "gold standard" procedure for achalasia in the spectrum of current treatment options. the laparoscopic technique has proved superior to the thoracoscopic approach due to improved visualization of the esophagogastric junction. operative controversies most recently include the length of the myotomy, especially of its fundic part, with respect to the balance between postoperative persistent dysphagia and development of gastroesophageal reflux, as well as the type of the added antireflux procedure. perioperative mortality should approach 0%, and favorable long-term results can be achieved in > 90%.

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Surgery for achalasia: 1998

Cited by 25 publications

References 42 publications

Review article: the management of achalasia – a comparison of different treatment modalities¹

Review article: the management of achalasia – a comparison of different treatment modalities¹

Surgical Treatment of Achalasia: Current Status and Controversies

Impact of Minimally Invasive Surgery in the Spectrum of Current Achalasia Treatment Options

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Surgery for achalasia: 1998

Cited by 25 publications

References 42 publications

Review article: the management of achalasia – a comparison of different treatment modalities1

Review article: the management of achalasia – a comparison of different treatment modalities1

Surgical Treatment of Achalasia: Current Status and Controversies

Impact of Minimally Invasive Surgery in the Spectrum of Current Achalasia Treatment Options

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Product

Resources

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Review article: the management of achalasia – a comparison of different treatment modalities¹

Review article: the management of achalasia – a comparison of different treatment modalities¹