Midterm follow-up evaluation after a novel approach to anterior fundoplication for achalasia

Richardson, William; Kennedy, Colleen; Bolton, John S.

doi:10.1007/s00464-006-0227-9

Cited by 14 publications

(11 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ideally, this is done with randomized controlled trials, but in the case of achalasia that is difficult owing to the rarity of the disease and the inconsistencies among centers in the fine details of the therapies rendered. In the case of LHM the main variability in technique pertains to the antireflux procedure coupled with the myotomy: Dor fundoplasty, Toupet fundoplication, or none at all (7, 8). In the case of PD, there has been nearly uniform use of Rigiflex dilators (Boston Scientific, Natick, MA) since the mid 1990s, but enormous variability among centers in dilation protocol and in the utilization of 30, 35, or 40 mm diameter dilators (9).…”

Section: Introductionmentioning

confidence: 99%

Major Complications of Pneumatic Dilation and Heller Myotomy for Achalasia: Single-Center Experience and Systematic Review of the Literature

Lynch

Pandolfino

Howden

et al. 2012

American Journal of Gastroenterology

129

View full text Add to dashboard Cite

Background & Aims Pneumatic dilation (PD) and laparoscopic Heller myotomy (LHM) can be definitive therapies for achalasia; recent data suggest comparable efficacy. However, risk must also be considered. We reviewed the major complication rate of PD and LHM in a high volume center and reviewed the corresponding literature. Methods We reviewed 12 years of our institution’s achalasia treatment experience. During this interval a consistent technique of PD was used utilizing Rigiflex dilators. Medical records were reviewed for post-procedure complications. We administered a telephone survey and examined medical records to assess efficacy of treatment. We also performed a systematic review of the literature for comparable clinical data and examined 80 reports encompassing 12,494 LHM and PD procedures. Results At our center, 463 achalasia patients underwent 567 PD or LHM procedures. 78% of the PDs used a 30 mm Rigiflex dilator. 157/184 (85%) patients underwent 1 or 2 PD without any subsequent treatment. There were seven clinically significant perforations; one from PD and 6 from LHM. There were no resultant deaths from these perforations; two deaths occurred within 30 days of LHM from unrelated causes. Complications and deaths post-PD were significantly fewer than those post-LHM (p=.02). Conclusions Esophageal perforation from PD at our high-volume center was less common than often reported and lower than that associated with LHM. We conclude that, in the hands of experienced operators using conservative technique, PD has fewer major complications and deaths than LHM.

show abstract

Section: Introductionmentioning

confidence: 99%

Major Complications of Pneumatic Dilation and Heller Myotomy for Achalasia: Single-Center Experience and Systematic Review of the Literature

Lynch

Pandolfino

Howden

et al. 2012

American Journal of Gastroenterology

129

View full text Add to dashboard Cite

show abstract

“…Although the etiology of achalasia remains elusive, the mainstay of therapy is directed towards reduction of LES pressure to improve esophageal emptying by gravity [2] . Treatment for achalasia includes drug therapy [3], botulinum toxin (BoTx) injection [4,5] , pneumatic dilatation (PD) [6,7] and Heller myotomy (HM) [8][9][10] . Among these, PD and HM are the most common treatment methods for untreated achalasia [11] .…”

Section: Introductionmentioning

confidence: 99%

Recurrent achalasia treated with Heller myotomy: A review of the literature

Wang¹,

Li²

2008

WJG

View full text Add to dashboard Cite

AIM:To evaluate the efficacy and safety of Heller myotomy (HM) for recurrent achalasia, performed after different methods of first-line treatment. METHODS:We searched for studies published in PubMed from 1966 to March 2008 on treatment of recurrent achalasia with HM after failure with different methods of first-line treatment. The efficacy of HM was assessed by a pooled estimate of response rate with individual studies weighted proportionally to sample size. RESULTS: Sixteen studies were eligible and included in the review. The results showed that HM has a better remission rate for recurrent achalasia after failure of HM [weighted mean (SD)] of 86.9% (21.8%) compared with 81.6% (23.8%) for pneumatic dilatation (PD). One study evaluated the efficacy of HM after failure of PD combined with botulinum toxin injection (83%). The most common complications were perforation and gastroesophageal reflux. CONCLUSION: HM has the best efficacy in patients with recurrent achalasia who were treated with HM as first-line treatment. Future studies should focus on how to increase the success rate and decrease the complications of HM.

show abstract

“…Laparoscopic cholecystectomy has been regarded as the gold standard of care since the mid-1990s. 1 Equal advances have occurred in regard to hernia, 2, 3 foregut, [4][5][6] bariatric, 7, 8 endocrine 9, 10 and colorectal surgery. [11][12][13] The acceptance of minimally invasive procedures continues to allow surgeons to explore new avenues to apply laparoscopic techniques to progressively difficult procedures.…”

mentioning

confidence: 99%

Laparoscopic and Open Distal Pancreatectomy: A Comparison of Outcomes

Finan

Cannon

Kim

et al. 2009

The American Surgeon™

View full text Add to dashboard Cite

Laparoscopic (lap) pancreatic surgery has been increasingly reported since its introduction in 1992. A retrospective analysis of consecutive patients undergoing elective lap and open distal pancreatectomy from 2002 to 2007 was performed. Univariate analysis was completed to evaluate perioperative variables. Logistic regression analysis was used to model predictors of postoperative pancreatic fistula. One hundred forty-eight subjects underwent distal pancreatectomy; 98 completed open, 44 lap, and six converted to open. There was no significant difference in the incidence of postoperative morbidity or mortality between the surgical approaches. Decreased operative time (156 vs 200 minutes, P < 0.01), blood loss (157 vs 719 mL, P < 0.01), and length of stay (5.9 vs 8.6 days, P < 0.01) were seen in the lap group. There was no significant difference in the rate of all pancreatic fistula formation (50 vs 46%, P = 0.94) or clinically significant leaks (18 vs 19%, P = 0.97) between techniques. A preoperative biopsy-proven cancer, increasing body mass index, history of pancreatitis, and male gender were significant predictors of having a pancreatic fistula. Lap and open distal pancreatectomy are performed safely at high-volume pancreatic surgery centers. This report provides ongoing support of the feasibility and safety of the lap approach with improved perioperative outcomes and equivalent pancreatic fistula rate.

show abstract

Midterm follow-up evaluation after a novel approach to anterior fundoplication for achalasia

Abstract: Heller myotomy provides excellent dysphagia relief with or without fundoplication. Heartburn is a significant problem for a minority of patients. In the authors' hands, Toupet had the worst results and modified Dor was most protective for heartburn.

Cited by 14 publications

References 14 publications

Major Complications of Pneumatic Dilation and Heller Myotomy for Achalasia: Single-Center Experience and Systematic Review of the Literature

Major Complications of Pneumatic Dilation and Heller Myotomy for Achalasia: Single-Center Experience and Systematic Review of the Literature

Recurrent achalasia treated with Heller myotomy: A review of the literature

Laparoscopic and Open Distal Pancreatectomy: A Comparison of Outcomes

Contact Info

Product

Resources

About