Reasons and Prevalence of Reoperations After Esophagomyotomy for Achalasia

Li, Jihui; Lieb, Jayne; Gianos, Melissa; Szomstein, Samuel; Sesto, Mark E.; Rosenthal, Raúl J.

doi:10.1097/sle.0b013e3182632d7a

Cited by 7 publications

(4 citation statements)

References 21 publications

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“…Of the 166 patients in this group,[ 4 5 12 13 14 15 16 17 18 19 ] the cause of failure was described in 93. In 64, the cause of the failure was incomplete myotomy, in 23 was the presence of fibrosis and in 6 the combination of the both.…”

Section: Resultsmentioning

confidence: 99%

“…The re-LHM is the procedure with the highest number of publications, doubling the publications related to PD and POEM, and with a greater number of patients included. However, the initial procedure chosen by the majority of the authors (67%)[ 4 10 17 19 20 21 22 23 ] after the ineffectiveness of the surgical myotomy was PD.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors prefer to initially perform a re-LHM in patients with dysphagia of early onset. [ 5 17 30 31 32 ]…”

Section: Discussionmentioning

confidence: 99%

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What to do when Heller's myotomy fails? Pneumatic dilatation, laparoscopic remyotomy or peroral endoscopic myotomy: A systematic review

et al. 2018

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Background:Surgical treatment of achalasia fails in 10%–20% of patients. The most frequent responsible cause is the performance of an incomplete myotomy at primary surgery. The treatment when the failure happens is not well defined. In this study, we review and evaluate the possible treatments to be carried out when surgical myotomy fails. We define its benefits and results, with the purpose of defining a therapeutic algorithm.Materials and Methods:The systematic review was performed following the guidelines established by the Meta-analysis of Observational Studies in Epidemiology statement. We searched several electronic databases (MEDLINE, PubMED, EMBASE and Cochrane) from January 1991 to March 2017, with the keywords 'recurrent achalasia' 'POEM remyotomy', 'esophagomyotomy failure', 'Heller myotomy failure', 'myotomy failure', 'pneumatic balloon dilatation achalasia' and combinations between them, 'redo Heller', 'redo myotomy', 'reoperative Heller'.Results:A total of 61 observational studies related to the treatment of patients with failure of Heller's myotomy were initially found. Finally, 37 articles were included in our study that provided data on 289 patients. Of these 289 patients, diagnosed of failed Heller's myotomy, 87 were treated with pneumatic dilatation (PD), 166 underwent surgical revision and finally 36 were treated with POEM. No randomised controlled trial was identified.Conclusions:The three therapeutic options analysed in this review are effective and safe in the treatment of patients with achalasia with failure of surgical myotomy. The best results can be achieved following an algorithm similar to the one proposed here, where each procedure must be performed by well-experienced team in the selected modality.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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What to do when Heller's myotomy fails? Pneumatic dilatation, laparoscopic remyotomy or peroral endoscopic myotomy: A systematic review

et al. 2018

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“…Often, redo myotomy is pursued only after failures of previous PD attempts, but many choose to redo the myotomy as the first line of intervention when faced with recurrence or persistence of dysphagia after HM. 67,68 The most frequent complication reported is mucosal perforation, 69 but there is no confirmation in the literature that the previous PD can increase the risk of perforation in the reoperation. 70…”

Section: Redo Esophageal Myotomymentioning

confidence: 99%

Achalasia: what to do in the face of failures of Heller myotomy

Felix

Murayama

Bonavina

et al. 2020

Annals of the New York Academy of Sciences

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Achalasia is a primary motility disorder of the esophagus, and while there are several treatment options, there is no consensus regarding them. When therapeutic intervention for achalasia fails, a careful evaluation of the cause of the persistent or recurrent symptoms using upper endoscopy, esophageal manometry, and contrast radiologic studies is required to understand the cause of therapy failure and guide plans for subsequent treatment. Options for reintervention are the same as for primary intervention and include pneumatic dilation, botulinum toxin injection, peroral endoscopic myotomy, or redo esophageal myotomy. When reintervention fails or if the esophagus is not amenable to intervention and the disease is considered end‐stage, esophagectomy is the last option to manage recurrent achalasia.

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