A short 4-cm oesophageal myotomy relieves the obstructive symptoms of achalasia☆

Almarhabi, Yahya; D’Journo, Xavier Benoît; Chen, Long-Qi; Martin, Jocelyne; Ferraro, Pasquale; Duranceau, André

doi:10.1016/j.ejcts.2009.04.060

Cited by 5 publications

(5 citation statements)

References 19 publications

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“…[10] Some controversies exist about the extensiveness of myotomy of the esophagus and stomach. [2] Limitation of gastric myotomy to prevent or mitigate gastroesophageal reflux may have no beneficiation of dysphagia. [11] An aggressive myotomy that destroys the entire LES is most likely to improve esophageal emptying in patients with achalasia.…”

Section: Discussionmentioning

confidence: 99%

“…[1] Palliation of dysphagia remains the first goal of therapy as the motor dysfunction persists after the operation. [2] A modified Heller's myotomy is considered at present the most efficient long-term solution. It is often proposed as the firstline treatment.…”

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confidence: 99%

“…[7] Controversy still persists regarding the ideal length of myotomy to treat oesophageal achalasia. [2] The aim of this study was to show the functional results of a short- and long-segment esophagogastric myotomy and partial Dor fundoplication for the relief of symptoms of achalasia.…”

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confidence: 99%

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Results of short- and long-segment cardioesophageal myotomy for achalasia

Aghajanzadeh

Moghadam

Hemmati

et al. 2012

Saudi J Gastroenterol

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Background/Aim:We report the results of a short- and long-segment cardiomyotomy for relief of the symptoms of achalasia.Patients and Methods:From 1997 to 2009, 41 patients (22 men, 19 women) with achalasia underwent cardiomyotomy. Patients were divided into 2 groups [short-segment group (SSG) and long-segment group (LSG)]. SSG include 22 patients with laparotomy and 8-cm short-segment myotomy and Dor fundoplication. LSG includes 19 patients with thoracotomy and 12-cm long-segment myotomy and Belsey partial fundoplication.Results:Median follow up was 48 months (range: 12–70 months). Postoperative dysphagia improved in 20 patients in SSG and in 17 patients in LSG (P < 0.001). Slow emptying sensation improved in 19 patients in SSG and in 16 patients in LSG postoperatively (P < 0.001). Heartburn was present in 2 patients in SSG and 3 patients in LSG postoperatively (P = 0.179). Radiologically, barium stasis decreased significantly from 88% to 25% in SSG and from 85% to 30% in LSG. The lower esophageal sphincter (LES) gradient decreased from 32 to 10 mmHg in SSG and from 34 to 14 mmHg in LSG (P < 0.001).Conclusions:Short-segment cardiomyotomy reduces the LES gradient and relieves obstructive symptoms.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Results of short- and long-segment cardioesophageal myotomy for achalasia

Aghajanzadeh

Moghadam

Hemmati

et al. 2012

Saudi J Gastroenterol

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“…A 6-cm short myotomy (4 cm of the esophagus and 2 cm of the stomach) reduces LES gradient, improves LES relaxation, and relieves obstructive symptoms and improves esophageal emptying. 70 A short myotomy does not have a suffi cient length to prevent postoperative GER. An adequate myotomy should therefore include 5-6 cm of the distal esophagus and also be extended by least 2 cm on the gastric fundus.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment for achalasia: when should it be performed, and for which patients?

Kashiwagi

Omura

2011

Gen Thorac Cardiovasc Surg

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Achalasia is a rare motor disorder of the esophagus, characterized by the absence of peristalsis and impaired swallow-induced relaxation. In the past decade, evidence has been accumulated suggesting that achalasia may be an immune-mediated inflammatory disorder. With the advent of minimally invasive surgery, laparoscopic Heller myotomy (LHM) has slowly shifted the treatment of achalasia toward the greater use of surgical therapy. The goal of both surgical and nonsurgical treatment is to eliminate the outflow obstruction afforded by a nonrelaxing sphincter, relieving dysphagia and maintaining a barrier against gastroesophageal reflux (GER). Endoscopic botulinum toxin injection (EBTI) is safe, easy to perform, inexpensive, and effective in aged patients, and it is especially effective when the lower esophageal pressure is hypertonic. This therapeutic option is reserved for patients too ill to undergo any surgical procedure. Pneumatic dilation (PD) has been shown to be an effective and inexpensive treatment with few adverse effects. The long-term success rate of PD seems to drop progressively over time. Heller myotomy (HM) has shown the best clinical efficacy in achalasia as a first-line treatment. Multiple endoscopic treatments are associated with poorer outcomes after HM. EBTI also makes LHM more difficult and results in a worse surgical outcome. The inferior symptomatic outcomes after thoracoscopic HM may be caused by the difficulty in extending an adequate myotomy onto the stomach from the chest and the inability to create a fundoplication. LHM with Dor's fundoplication (LHM + Dor) is effective and is safer procedure for avoiding GER, dysphagia, mucosal perforation, and a pseudodiverticulum. LHM + Dor is also effective in the presence of sigmoid achalasia, but the clinical result is not as good as nonsigmoid achalasia. A few patients need esophagectomy for surgical failure of HM. However, considering the risk of esophagectomy, LHM + Dor is the first treatment option for patients with achalasia regardless of the degree of esophageal dilatation. This procedure is therefore considered to be an effective and safe treatment for patients of any age or with any condition.

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“…The ideal length of myotomy on the gastric side below the GEJ continues to be a matter debate. [13][14][15][16][17][18][19] The aim of this retrospective study was to compare the impact of the extent of myotomy on the gastric side on the outcome of laparoscopic Heller cardiomyotomy for patients with achalasia.…”

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confidence: 99%

Impact of the Myotomy Extent on Gastric Side on Surgical Outcome After Heller’s Cardiomotomy for Achalasia

Nakeeb

Ezzat

Shehta

et al. 2019

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Background: Laparoscopic Heller cardiomyotomy (LHM) with Dor fundoplication represents the most commonly accepted surgical management for achalasia. The ideal extent of myotomy on the gastric side remains a matter of continuous debate. The aim of this study was to compare the impact of the extent of myotomy on the gastric side on the outcome of LHM.Patients and Methods: Patients with achalasia who underwent LHM included in the study. The patients were classified according to the length of the gastric myotomy into 3 groups (group I: <1.5 cm, group II: 1.5 to 2.5 cm, and group III: > 2.5 cm).Results: In total, 212 patients (94 males and 118 females) with achalasia treated by LHM and Dor fundoplication included in the study. No statistically significant differences were found among the 3 groups as regards preoperative data, intraoperative mucosal perforation, operative time, blood loss, and hospital stay. The incidence of persistent dysphagia was significantly higher in the group I. Postoperative GERD symptoms were significantly higher in group III (23.3%, P < 0.0001). Recurrent achalasia was significantly higher in group I with 11 patients (15.9%), 8 patients in group II (7.1%), and nil in group III (P < 0.02).Conclusions: Longer myotomy on the gastric side ( > 2.5 cm) ensures complete division of the LES with better outcomes in term of resolution of dysphagia but may be associated with higher postoperative GERD. Therefore, a myotomy length of 1.5 to 2.5 cm on the gastric side provides a balance between relieve of dysphagia and development of postoperative GERD.

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A short 4-cm oesophageal myotomy relieves the obstructive symptoms of achalasia☆

Cited by 5 publications

References 19 publications

Results of short- and long-segment cardioesophageal myotomy for achalasia

Results of short- and long-segment cardioesophageal myotomy for achalasia

Surgical treatment for achalasia: when should it be performed, and for which patients?

Impact of the Myotomy Extent on Gastric Side on Surgical Outcome After Heller’s Cardiomotomy for Achalasia

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