100 Consecutive Minimally Invasive Heller Myotomies: Lessons Learned

Sharp, Kenneth W.; Khaitan, Leena; Scholz, Stefan; Holzman, Michael D.; Richards, William O.

doi:10.1097/00000658-200205000-00004

Cited by 142 publications

(105 citation statements)

References 28 publications

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“…In recent years, laparoscopic HM, with or without fundoplication, has increasingly been performed because of the lower morbidity and shorter recovery period associated with laparoscopic surgery [51] . Some surgeons [52] prefer a posterior partial fundoplication instead of an anterior hemifundoplication. It prevents reflux more effectively and keeps the edges of the myotomy separate.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

confidence: 99%

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

Wang¹,

Li²

2008

WJG

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“…However, in most western countries, the majority of patients undergo LM, with excellent results [54] . Some workers regard LM as the gold standard treatment for achalasia [55] . More randomized controlled trials should be carried out in China to evaluate the effect of LM.…”

Section: Effects Of the Treatment Of Achalasiamentioning

confidence: 99%

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

Wang

Li²,

Li³

et al. 2008

WJG

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AIM:To evaluate the effect of different approaches in the treatment of achalasia in China. METHODS:We performed a systematic review and meta-analysis of Chinese literature by searching the Chinese Biomedical Database and Chinese scientific Journals database (up to March 2008). All cohort studies (controlled or uncontrolled) in which the patients were observed for more than a year were reviewed in detail. Dichotomous outcomes were reported as relative risks (RR) with 95% confidence interval (CI) for controlled trials. The efficacy in uncontrolled trials was assessed by a pooled estimate of response rate with individual studies weighted in proportion to the sample size. RESULTS: Seven controlled trials compared the effect of botulinum toxin injection (BoTx) with pneumatic dilation (PD

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“…Comparison between series with no fundoplication, partial or total fundoplication presented different results [16 -20]. The automatic relationship between myotomy and reflux has been recently denied by Sharp et al [16] are now conducting a randomized trial to compare the effective need for a Dor fundoplication with a Heller myotomy. On the contrary, Ponce et al [17] found a relatively frequent presence of reflux despite open myotomy and Dor fundoplication.…”

Section: Discussionmentioning

confidence: 99%

“…The difficulty in evaluating the effectiveness of each surgical technique depends also on the subjective criteria of evaluation and mix of symptoms not always correlated with dysphagia or with reflux [16]. Objective data (i.e.…”

Section: Discussionmentioning

confidence: 99%

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

Mineo

Ambrogi

2004

European Journal of Cardio-Thoracic Surgery

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Objective: To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia. Methods: Thirty-nine patients with achalasia (25 males, mean age 42^13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1 ¼ no symptoms; 4 ¼ persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30^34 mmHg. Six patients had undergone previous pneumatodilation. Results: No procedure related mortality was recorded. Mean follow-up was 107^30 months (54 -177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3^8.3 mmHg ðP , 0:001Þ; in oesophageal width was 11.5^7.1 mm ðP , 0:001Þ; in dysphagia 1.8^0.8 ðP , 0:01Þ and regurgitation 1.4^0.7 ðP , 0:01Þ: Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement ðP , 0:001Þ especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure. Conclusion: Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia. q

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100 Consecutive Minimally Invasive Heller Myotomies: Lessons Learned

Cited by 142 publications

References 28 publications

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

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

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

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