Long-term outcome of esophageal myotomy for achalasia

Abstract

Esophageal myotomy for achalasia can reduce the resting pressures of the esophageal body and LES and improve esophageal transit and dysphagia. Myotomy in combination with antireflux procedure can prevent gastroesophageal reflux to a certain extent, but further randomized studies should be carried out to demonstrate its efficacy.

Short and long term results of the laparoscopic Heller–Dor myotomy. The influence of age and previous conservative therapies

“…It is widely accepted that the majority of patients should be treated by the modality that appears to warrant a combination of low initial morbidity, high success rate and good long-term outcome. Pneumatic dilatation and surgical myotomy improve dysphagia in the short term in a high percentage of patients [9], but beyond five to 10 years, only 26 to 49% of patients after pneumatic dilatation [1,10,11] versus 33 to 79% after surgical myotomy [1,6,10,12] are free from dysphagia. However, 33 to 38% of patients with recurrent dysphagia manage symptoms without any medical help [10].…”

The Preoperative Manometric Pattern Predicts the Outcome of Surgical Treatment for Esophageal Achalasia

“…In a minority of patients (estimated between 5% and 15%), however, symptoms persist or recur after surgery. [5][6][7][8][9][10] It is hard to say why the treatment sometimes fails: a technical defect (incomplete myotomy) may be the culprit in some cases (especially if the failure occurs soon after surgery or symptoms persist) but, in most cases, the reason for the failure remains obscure. 11,12 A new esophageal achalasia classification-obtained using high-resolution manometry (HRM), which records the pressure readings from 36 sensors placed 1 cm apart and enables pressure topography plotting-has recently been proposed, which considers three different manometric patterns: type I, achalasia with minimal esophageal pressurization; type II, achalasia with esophageal compression; type III, achalasia with spasm.…”

Revisional Surgery after Heller Myotomy for Treatment of Achalasia: A Comparative Analysis Focusing on Operative Approach

“…Published studies came from various centers across the globe, majority from Europe (30.3%), the USA (42.4%), the and UK (12.1%). From Asia [38,41] and Canada [20,27], two reports each were published. Mean age was provided only in 54.5% of articles.…”