Long-term Results of Esophagomyotomy for Achalasia of Esophagus

Jara, F; Toledo-Pereyra, L. H.; Lewis, Jeffrey W.; Magilligan, Donald J.

doi:10.1001/archsurg.1979.01370320067011

Cited by 118 publications

(41 citation statements)

References 5 publications

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“…Interestingly, this study showed that surgeons performing Heller myotomy as a primary procedure have also performed an additional procedure at the same time, the most likely reason being to prevent postoperative reflux. Procedures such as truncal vagotomy [10,11], pyloroplasty [10,11,16], cardioplasty [10], antrectomy [11,12,21,27], Belsey repair [14,26,27,32], and roux-en-Y gastrojejunostomy [12,21,23,27,30] have been documented.…”

Section: Resultsmentioning

confidence: 99%

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

Gouda

Nelson²,

Bhoyrul

2012

Indian J Surg

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Surgical myotomy is the gold standard in therapy for achalasia, but treatment failures occur and require revisional surgery. A MEDLINE search of peer-reviewed articles published in English from 1970 to December 2008 was performed using the following terms: esophageal achalasia, Heller myotomy, and revisional surgery. Thirty-three articles satisfied our inclusion criteria. A total of 12,727 patients, with mean age of 43.3 years (males 46% and females 50%), underwent Heller myotomy (open 94.8% and laparoscopic 5.2%). Revisional surgery was performed in 6.19%. Procedures performed included revision of the original myotomy or creation of a new myotomy with or without an antireflux procedure or esophagectomy. Reasons for reoperation were incomplete myotomy (51.8%), onset of reflux (34%), megaesophagus (16.2%), and esophageal carcinoma (3.04%). Systematic review of the literature for revisional surgery following Heller myotomy revealed a 6.19% rate of reoperation with a low mortality rate.

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Section: Resultsmentioning

confidence: 99%

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

Gouda

Nelson²,

Bhoyrul

2012

Indian J Surg

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“…In order to avoid this burdensome complication, a second group of authors [2,3,9,[11][12][13][14][15][16][17][18][19][20] prefer to com plete Heller's myotomy with an antireflux mechanism. In this respect, the 360° fundoplication has proved to be the most efficient treatment [24], For this reason some surgeons [9,[14][15][16] associate it systematically with myo tomy, reporting in their series a minimum percentage of postoperative reflux, which was evaluated using clinical, radiological and isotopic studies.…”

Section: Discussionmentioning

confidence: 99%

“…Lastly, we must consider the convenience of long term follow-up as, according to some authors [3,13,25], the incidence of postoperative reflux increases with time. In our study, the follow-up was at least 5 years, and although the results were satisfactory, we think it is nec essary to make further checks to ensure that our surgical procedure is efficient.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Gastroesophageal Reflux following Heller’s Myotomy Associated with a 270° Posterior Partial Fundoplication

Paricio¹,

Escandell²,

Haro³

et al. 1990

Dig Surg

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By means of clinical, endoscopic, manometric and pH metric studies, the incidence of gastroesophageal reflux in 30 patients with achalasia of the cardia was evaluated at least 5 years after undergoing surgical treatment using Heller’s myotomy associated with a 270° posterior partial fundoplication. Our results show that the procedure is efficient, not only because it obtains improvement or total disappearance of the achalasia symptoms, but also because it prevents postoperative gastroesophageal reflux, which was only recorded in 10% of the cases.

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“…19) However, one study reported that gastroesophageal reflux develops during long-term followup in 48% of patients who undergo myotomy alone. 20) A general consensus has been reached that some type of anti reflux procedure should be performed concurrently with myotomy to prevent postoperative gastroesophageal reflux. Technically, anti reflux procedures are easier to perform via a transabdominal rather than a transthoracic approach.…”

Section: Surgical Therapymentioning

confidence: 99%

Recent Trends in the Management of Achalasia

Katada

Sakuramoto

Yamashita

et al. 2012

ATCS

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Radical treatment for achalasia is currently unavailable. At present, most palliative procedures are designed improve the passage of food through the gastroesophageal junction and thereby alleviate symptoms. Drug therapy is of limited, transient effectiveness. Pneumatic dilation (PD) is considered superior to endoscopic botulinum toxin injection (EBTI). The mainstay of surgical treatment for achalasia is laparoscopic Heller myotomy (LHM) with fundoplication, currently considered superior to PD. Per oral endoscopic myotomy (POEM), a "state-of-the-art" procedure for minimally invasive surgery, holds great promise for the future management of achalasia. Definitive conclusions regarding the benefits and risks of currently available treatments for achalasia must await the accumulation of evidence from well-designed clinical trials.

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Long-term Results of Esophagomyotomy for Achalasia of Esophagus

Cited by 118 publications

References 5 publications

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

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

Assessment of Gastroesophageal Reflux following Heller’s Myotomy Associated with a 270° Posterior Partial Fundoplication

Recent Trends in the Management of Achalasia

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