Esophagectomy for achalasia: patient selection and clinical experience

Devaney, Eric J.; Iannettoni, Mark D.; Orringer, Mark B.; Marshall, Becky

doi:10.1016/s0003-4975(01)02890-9

Cited by 178 publications

(182 citation statements)

References 11 publications

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“…Several types of esophagectomy are proposed in the literature believing that resection of the diseased esophagus leads to a marked functional improvement. However, for a benign disease, such a major procedure with associated significant morbidity (30 %) and mortality (2 %) is difficult to accept [4]. This subtype of achalasia still represents a surgical challenge.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Esophagogastroplasty in Management of Megaesophagus with Axis Deviation

et al. 2014

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The results of cardiomyotomy in patients of achalasic megaesophagus with axis deviation are not satisfactory. Usually, an esophagectomy is advocated. We describe the technical details and outcomes of laparoscopic esophagogastroplasty for end-stage achalasia. The patient had end-stage achalasia, characterized by tortuous megaesophagus with axis deviation. The surgery was performed in supine position using four abdominal ports. The steps included mobilization of the gastroesophageal junction and lower intrathoracic esophagus, straightening the pulled intrathoracic esophagus into the abdomen, and a side-side esophagogastroplasty using purple Endo GIA Articulating Tri-Staple load, two firings. Duration of surgery was 52 min. The patient was ambulated on the first postoperative day. Oral feeding was initiated by the third postoperative day. The patients had significant improvements of dysphagia. At 3 months of follow-up, the patient is euphagic without significant symptoms of gastroesophageal reflux. Laparoscopic esophagogastroplasty is an effective option for relieving dysphagia in megaesophagus due to achalasia with axis deviation. It is a reasonable alternative before subjecting to a major and potentially morbid esophagectomy. It creates a large gastroesophageal (GE) junction, which, with the help of gravity, helps food transit. By dividing the muscles of the GE junction completely, it also achieves a complete cardiomyotomy. Less operative time and blood loss, quicker recovery, and better cosmesis make it an attractive option. While potential reflux is a possibility, the reported case has not shown significant GERD symptoms.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Esophagogastroplasty in Management of Megaesophagus with Axis Deviation

et al. 2014

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“…19,55,56 Others recommend esophagectomy as the first-choice treatment believing that marked esophageal dilatation and redundancy predict the impossibility of improving emptying by means of myotomy. 57,58 Furthermore achalasia is considered to be precancerous with a reported incidence of 0.2%-2.0%. 59 The chronic irritation in achalasia leads to squamous hyperplasia which progress to dysplasia and eventually to carcinoma.…”

Section: Choice Of Treatmentmentioning

confidence: 99%

Achalasia: What is the best treatment?

Ahmed

2008

Ann Afr Med

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Background: Achalasia is an infrequent primary motility disorder of the esophagus. Because of uncertain etiology, treatment is only palliative and is directed at decreasing lower esophageal sphincter pressure, improving esophageal emptying and relieving the symptoms of achalasia. Current treatment options include pharmacological, endoscopic and surgical. We undertook a systematic literature review of the management strategies currently available for achalasia. Method: A Medline, PubMed and Cochrane database search was conducted using reference manager 11. Original articles and reviews published in the English literature on the management of achalasia were reviewed. Emphasis was placed on articles published in the last ten years on randomized controlled trials comparing the various forms of treatment. Results: Esophageal manometry is the standard diagnostic evaluation for achalasia. Accurate diagnosis can also be made based on clinical findings and barium esophagogram. Medical treatment with nitrates or calcium channel blockers has variable results in alleviating the symptoms of achalasia but long-term results are disappointing because of tolerance and side effects. Intrasphincteric injection of botulinum toxin, pneumatic dilatation and surgical myotomy are variably effective at controlling the symptoms of achalasia but each modality has specific strength and weaknesses which make their choice suitable in a particular group of patients. While pneumatic dilatation is superior to botulinum toxin injection surgical myotomy provides the best long-term control of symptoms in patients with achalasia. Conclusion: Laparoscopic myotomy should be the initial treatment for most patients with achalasia. Pneumatic dilatation is the most cost-effective alternative but its long-term efficacy is less than that of surgical myotomy. Endoscopic botulinum toxin injection can be considered when other forms of treatment are contraindicated. Key words: Achalasia, Heller's esophagomyotomy, pneumatic dilatationRésumé Contexte: L'achalasie est une rare anomalie motrice de l'oesophage. En raison de son étiologie incertaine, le traitement est seulement palliatif et vise la réduire la pression sphinctérienne du bas oesophage, l'amélioration de la vidange et le soulagement des symptômes de l'achalasie. Les options thérapeutiques courantes font appel aux moyens pharmacologiques, endoscopiques et chirurgicaux. Nous avons effectué une revue systématique de la littérature relative aux stratégies thérapeutiques actuellement disponibles pour l'achalasie. Méthode: Une recherche sur Medline, Pubmed et Cochrane a été faite a l'aide du logiciel Reference Manager 11. Les articles originaux et les rapports portant sur la prise en charge de l'achalasie et publiés en anglaise ont été passés en revue. L'accent a été mis sur les articles publiés au cours des dix dernières années et sur les essais contrôlés comparant les diverses formes de traitement. Résultats: La manométrie oesophagienne est la méthode de diagnostic standard pour l'achalasie. Le dia...

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“…Using a transhiatal approach in 94% of cases, Devaney et al [21] observed mortality in 2%, complications in 30%, and anastomosis dehiscence in 10% of cases, whereas 88% of the patients were satisfied with the procedure. Molena and Yang [22] reported excellent results of using a transthoracic approach in esophagectomy and the stomach as the plasty organ.…”

Section: Introductionmentioning

confidence: 99%

“…Various authors recommend esophageal resection in the case of recurrence or persistence of symptoms after Heller surgery [13][14][15][16][17] . Csendes et al [18] reported poor results of Heller surgery in 20% of patients after 10 years of follow-up and in 35% after 20 years.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive esophagectomy in achalasia: a more liberal approach to esophageal resection

Crema¹,

Júnior²,

Terra³

et al. 2017

MIS

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Aim:The advent of minimally invasive abdominal and thoracic surgeries has led to a meaningful reduction in complication and mortality rates among patients undergoing esophagectomy, especially when used for the treatment of benign diseases such as megaesophagus. Methods: Two hundred thirty-one patients, 152 (65.8%) men and 79 (34.2%) women, with a mean age of 52.46 (19-80) years, were treated for advanced megaesophagus between September 1996 and October 2016. Two hundred ten patients (90.91%) had chagasic megaesophagus and 21 patients (9.09%) had idiopathic megaesophagus. Results: Immediate complications were observed in 37 patients (16.01%): hemopneumothorax in 22 cases (9.52%), gastric stasis in 11 (4.76%), cervical fistula in 11 (4.76%), dysphonia in 18 (7.8%), and mediastinitis in 1 case (0.43%). Two patients (0.86%) died: 1 patient with a pacemaker died of cardiorespiratory arrest on postoperative day 12 and the other patient died of mediastinitis on day 28. Our standardized protocol includes nutritional and pulmonary outpatient care. Conclusion: With a standardized multidisciplinary protocol and a team adequately trained in laparoscopy, minimally invasive esophagectomy is an excellent option for the treatment of advanced megaesophagus. The technique is easily standardized and reproducible, and provides excellent postoperative outcomes. Key words:Advanced megaesophagus, vagal preservation, transhiatal esophagectomy, laparoscopic esophagectomy ABSTRACTArticle history:

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Esophagectomy for achalasia: patient selection and clinical experience

Cited by 178 publications

References 11 publications

Laparoscopic Esophagogastroplasty in Management of Megaesophagus with Axis Deviation

Laparoscopic Esophagogastroplasty in Management of Megaesophagus with Axis Deviation

Achalasia: What is the best treatment?

Minimally invasive esophagectomy in achalasia: a more liberal approach to esophageal resection

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