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

Ferulano, G. P.; Dilillo, S; D’Ambra, Michele; Lionetti, Ruggero; Brunaccino, Rossella; Fico, Domenico; Pelaggi, Domenico

doi:10.1007/s00464-007-9506-3

Cited by 27 publications

(14 citation statements)

References 17 publications

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“…No difference in outcome was found for 15 patients older than aged 70 years in a series of 31 patients [24], but patients with “severe” achalasia were excluded and the trial was underpowered. Likewise, no difference in outcome was found in 70 patients older than aged 60 years in a series of 407 patients [25].…”

Section: Discussionmentioning

confidence: 99%

Excellent outcomes of laparoscopic esophagomyotomy for achalasia in patients older than 60 years of age

Roll

Gasper

et al. 2010

Surg Endosc

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BackgroundThe effectiveness of an esophagomyotomy for dysphagia in elderly patients with achalasia has been questioned. This study was designed to provide an answer.MethodsA total of 162 consecutive patients with achalasia who had a laparoscopic myotomy and Dor fundoplication and who were available for follow-up interview were divided by age: <60 years (range, 14–59; 118 patients), and ≥60 years (range, 60–93; 44 patients). Primary outcome measures were severity of dysphagia, regurgitation, heartburn, and chest pain before and after the operation as assessed on a four-point Likert scale, and the need for postoperative dilatation or revisional surgery.ResultsFollow-up averaged 64 months. Older patients had less dysphagia (mean score 3.6 vs. 3.9; P < 0.01) and less chest pain (1.0 vs. 1.8; P < 0.01). Regurgitation (3.0 vs. 3.2; P = not significant (NS)) and heartburn (1.6 vs. 2.0, P = NS) were similar. Older patients were no different in degree of esophageal dilation, manometric findings, number of previous pneumatic dilatations, or previous botulinum toxin therapy. None of the older patients had previously had an esophagomyotomy, whereas 14% of younger patients had (P < 0.01).After laparoscopic myotomy, older patients had better relief of dysphagia (mean score 1.0 vs 1.6; P < 0.01), less heartburn (0.8 vs. 1.1; P = 0.03), and less chest pain (0.2 vs. 0.8, P < 0.01). Complication rates were similar. Older patients did not require more postoperative dilatations (22 patients vs. 10 patients; P = 0.7) or revisional surgery for recurrent or persistent symptoms (3 vs. 1 patients; P = 0.6). Satisfaction scores did not differ, and more than 90% of patients in both groups said in retrospect they would have undergone the procedure if they had known beforehand how it would turn out.ConclusionsThis retrospective review with long follow-up supports laparoscopic esophagomyotomy as first-line therapy in older patients with achalasia. They appeared to benefit even more than younger patients.

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Section: Discussionmentioning

confidence: 99%

Excellent outcomes of laparoscopic esophagomyotomy for achalasia in patients older than 60 years of age

Roll

Gasper

et al. 2010

Surg Endosc

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“…Treatment options are directed toward relief of symptoms and improvement of health‐related quality of life (HRQoL) by reducing the pressure of the lower esophageal sphincter. Studies measuring HRQoL in achalasia are limited and most of them used generic instruments 1–10 or system‐specific measures 3,11–14 . Recently, a disease‐specific HRQoL questionnaire for achalasia was developed in English language, 15 but it has not been validated until more recently in Dutch 16 .…”

Section: Introductionmentioning

confidence: 99%

Disease-specific health-related quality of life in patients with esophageal achalasia before and after therapy

Garrigues

Ortiz

Casanova

et al. 2010

Neurogastroenterology &Amp; Motility

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“…Moreover, perforation is a severe complication for patients treated with PD as secondline treatment. Therefore, HM is becoming increasingly popular for treatment of recurrent achalasia [13][14][15][16] . However, the efficacy of HM is very much dependent upon first-line treatment, for reasons of symptom relapse or failure, and ag e and co-morbidity of patients.…”

Section: Introductionmentioning

confidence: 99%

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

Wang¹,

Li²

2008

WJG

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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.

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

Cited by 27 publications

References 17 publications

Excellent outcomes of laparoscopic esophagomyotomy for achalasia in patients older than 60 years of age

Excellent outcomes of laparoscopic esophagomyotomy for achalasia in patients older than 60 years of age

Disease-specific health-related quality of life in patients with esophageal achalasia before and after therapy

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

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