Two Decades of Experience with Modified Heller's Myotomy for Achalasia

Pai, Ganesh P.; Ellison, Robert G.; Rubin, Joseph W.; Moore, H. Victor

doi:10.1016/s0003-4975(10)62237-0

Cited by 42 publications

(10 citation statements)

References 20 publications

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“…The controversy over the necessity to perform an antireflux procedure with a Heller myotomy has been debated for decades [9,12,19,23,25,26,28,29]. Proponents argue that a short myotomy extending just beyond the gastroesophageal junction is difficult to calibrate; too short leads to residual dysphagia and too long leads to postoperative reflux [4,20].…”

Section: Discussionmentioning

confidence: 99%

Objective analysis of gastroesophageal reflux after laparoscopic heller myotomy: An anti-reflux procedure is required

et al. 2004

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Section: Discussionmentioning

confidence: 99%

Objective analysis of gastroesophageal reflux after laparoscopic heller myotomy: An anti-reflux procedure is required

et al. 2004

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“…39 A number of different methods of antireflux procedure following esophagomyotomy have been described in the literature. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Although the majority of the results of these different antireflux procedures seem quite satisfactory, the existence of so many different procedures for a single esophagomyotomy technique suggests they may have some advantages and disadvantages in comparison with one another. An added antireflux procedure prevented or decreased GER very effectively following transabdominal esophagomyotomy, 37 while the use of an antireflux procedure by total fundoplication over a myotomized esophagus was found to cause obstructive symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…A number of different antireflux procedures have been developed to treat reflux following myotomy. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Despite the excellent results reported for the Nissen antireflux procedure, 7,22 some authors have suggested that it is responsible for obstructive symptoms. 23,24 However, to our knowledge no comparative study to date has yet been made to determine which antireflux procedure prevents reflux more effectively and which is associated with the lowest incidence of postoperative transit problems.…”

Section: Introductionmentioning

confidence: 99%

Gastroesophageal Reflux and a Comparison of the Different Antireflux Procedures Following Esophagomyotomy: An Experimental Study in Rabbits

et al. 1998

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The surgical options for achalasia remain controversial regarding the surgical access route, whether it be transthoracic or transabdominal, the need of, and the type of an added antireflux procedure following an esophagomyotomy. These questions were investigated in an experimental study that used 30 albino rabbits divided into six groups, as follows: transabdominal Heller's esophagomyotomy (TAHE), transthoracic Heller's esophagomyotomy (TTHE), TAHE and Nissen total fundoplication (NF), TAHE and partial fundoplication (PF), TAHE and modified fundoplication (MF), and a control group. Esophageal transit time (ETT) and gastroesophageal reflux (GER) were evaluated by scintigraphy on the seventh postoperative day. When an esophagomyotomy was performed either with a transabdominal or transthoracic approach, a significantly increased GER rate was found in comparison to the controls. All types of antireflux procedures performed prevented GER effectively. Although NF and PF groups showed a significant delay in ETT when compared to the control group (P < 0.001), no such finding was observed in the MF group. In conclusion, an antireflux procedure following an esophagomyotomy is recommended. A modified fundoplication was thus found to be as effective as the other techniques in preventing GER, and was even a safer method when obstructive findings following a total or partial fundoplication were considered.

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“…Today the universally accepted procedure for surgical treatment of esophageal achalasia is the Heller myotomy [13], modified by Zaaijer [14]. It can be performed through an abdominal [15] or thoracic [16] approach. Myotomy can be performed by minimally invasive surgery (laparoscopic or thoracoscopic) and it achieves the same results as obtained by open surgery [17,18].…”

Section: Introductionmentioning

confidence: 99%

Comparative pre- and postoperative results analysis of functional state of the esophagus assessment in patients with various stages of achalasia☆

Оноприев¹,

Дурлештер²,

Ryabchun³

2005

European Journal of Cardio-Thoracic Surgery

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We suggest that dilating antireflux cardia provides adequate bolus passage and properly realizes antireflux barrier function, maintaining the esophageal distal pH within the physiological ranges even without esophageal peristalsis restoration, and dilating mechanism serve to prevent the recurrence of the disease. Despite excellent relief of dysphagia and functional state of the esophagus improvement, the main values of functional state assessment results in group III of patients were beyond physiological ranges.

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Two Decades of Experience with Modified Heller's Myotomy for Achalasia

Cited by 42 publications

References 20 publications

Objective analysis of gastroesophageal reflux after laparoscopic heller myotomy: An anti-reflux procedure is required

Objective analysis of gastroesophageal reflux after laparoscopic heller myotomy: An anti-reflux procedure is required

Gastroesophageal Reflux and a Comparison of the Different Antireflux Procedures Following Esophagomyotomy: An Experimental Study in Rabbits

Comparative pre- and postoperative results analysis of functional state of the esophagus assessment in patients with various stages of achalasia☆

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