Clinical results of thoracoscopic Heller's myotomy in the treatment of achalasia☆

Codispoti, Massimiliano; Soon, Sing Yang; Pugh, G.C.; Walker, William S.

doi:10.1016/s1010-7940(03)00432-9

Cited by 16 publications

(16 citation statements)

References 19 publications

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“…Critics of the operation have also cited the greater postoperative pain and the longer hospital stay after a thoracoscopic method compared with the laparoscopic operation as substantial disadvantages and the body of opinion has tended to favor the abdominal approach since it provides the opportunity to not only undertake the myotomy but address the potential future reflux problem. Nevertheless, a number of recent prospective studies demonstrate a continued albeit limited interest in this approach [24,25].…”

Section: Surgical Therapymentioning

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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Section: Surgical Therapymentioning

confidence: 99%

Surgical Treatment of Achalasia: Current Status and Controversies

et al. 2004

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“…In fact, it has been cited that there is a paucity of data in the literature with regard to long-term outcomes of patients following myotomy regardless of the operative technique. 8 The data from this series emphasize the importance of continued follow-up as the average time for patients to present with end stage disease was 12.5 years. Additionally, the finding of esophageal cancer in two of the eight patients in this series echoes the significance of long-term surveillance.…”

Section: Discussionmentioning

confidence: 75%

“…7 Additionally, some thoracic surgeons are proponents of the thoracoscopic technique. 8 The early results of esophageal myotomy performed by either technique have been favorable. 5,8,9 However, the failure rate for laparoscopic myotomy has been cited to be 10 to 20% requiring additional procedures to control persistent or recurrent symptoms.…”

mentioning

confidence: 99%

“…8 The early results of esophageal myotomy performed by either technique have been favorable. 5,8,9 However, the failure rate for laparoscopic myotomy has been cited to be 10 to 20% requiring additional procedures to control persistent or recurrent symptoms. 10 Furthermore, some reports on the long-term results of esophageal myotomy have suggested a deterioration of outcome over time.…”

mentioning

confidence: 99%

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Esophagectomy for End Stage Achalasia

Glatz

Richardson

2007

Journal of Gastrointestinal Surgery

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Esophageal myotomy is the standard primary therapy for achalasia. However, reports on long-term results of myotomy have suggested a deterioration of outcome over time with many patients presenting with end stage disease several years after esophagomyotomy. Eight patients who had previously undergone esophagomyotomy for achalasia presented with recurrent or worsening symptoms, and after preoperative evaluation, were treated by esophagectomy via laparotomy and right thoracotomy. The mean age at the time of myotomy was 52 years (range 18 to 62 years), and the mean time until esophagectomy was 12.5 years (range 2 to 18 years) after the initial myotomy. The median time until esophagectomy was performed after myotomy was 14 years. All patients in this series gained weight (mean, 23 pounds; range, 9 to 42 lbs) following esophagectomy, and none of the patients complained of dysphagia at follow-up or developed stricture. There were no major complications (including anastomotic leak) or deaths in this series. Five of the patients have been followed a mean of six years and remain well. Esophagectomy is a safe and appropriate treatment option in the setting of recurrent and end stage achalasia.

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“…Heller's myotomy is very effective in treating achalasia, but significant dysphagia or chest pain has been reported to persist or recur in 10-40% of patients treated by THM. However, a review of these series [5][6][7][8]18] indicates a very short mean follow-up time (0.8 years [range 0.1-4 years]). In this study with a much longer followup period of 5.9 years (range 2-14.6 years), persistent or recurrent dysphagia (grade 3-4) was present in seven patients (12.5%).…”

Section: Discussionmentioning

confidence: 99%