scholarly journals Laparoscopic Heller Myotomy and Dor Fundoplication for the Treatment of Esophageal Achalasia After Sleeve Gastrectomy—a Video Vignette

2020 ◽  
Author(s):  
Alberto Aiolfi ◽  
Diego Foschi ◽  
Marco Antonio Zappa ◽  
Alessandra Dell’Era ◽  
Emilia Bareggi ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Heller Myotomy ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Gastric Fundus ◽  
Esophageal Wall ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Dor Fundoplication ◽  
Esophageal Motility Disorder

Abstract Purpose Esophageal dysmotility and disorders of the lower esophageal sphincter are well documented in morbidly obese patients. Esophageal achalasia has been reported in up to 1% of obese patients but the development of such esophageal motility disorder after laparoscopic sleeve gastrectomy (LSG) is extremely rare. The purpose of this video was to demonstrate the management of a type II esophageal achalasia diagnosed in a 46-year-old female patient 4-year after LSG. Materials and Methods An intraoperative video has been anonymized and edited to demonstrate the feasibility of laparoscopic Heller myotomy and anterior Dor fundoplication on the mentioned patient. Results The operation started with the section of the perigastric adhesions. Proceeding in a clockwise direction, the esophagogastric junction, the anterior esophageal wall, and the His angle were freed. A residual slightly dilated fundus was found and isolated. After mobilization of the distal esophagus and identification of the anterior vagus nerve, a “hockey stick” myotomy was carried out for 6 cm on the esophagus and for 2 cm on the gastric side. An anterior Dor fundoplication was fashioned using the residual gastric fundus. Conclusion Esophageal achalasia in patients that previously underwent LSG is exceptional but should always be suspected in case of pathognomonic symptoms onset. In tertiary referral centers, laparoscopic Heller myotomy and, if technically feasible, an anterior Dor fundoplication seem safe and effective to relieve gastroesophageal outflow obstruction and prevent gastroesophageal reflux.

Laparoscopic heller myotomy and dor fundoplication for esophageal achalasia in children

2001 ◽  
Vol 36 (8) ◽  
pp. 1248-1251 ◽  
Author(s):  
Marco G. Patti ◽  
Craig T. Albanese ◽  
George W. Holcomb ◽  
Daniela Molena ◽  
Piero M. Fisichella ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Dor Fundoplication

scholarly journals Initial outcomes of laparoscopic Heller-Dor myotomy fundoplication for (esophageal) achalasia at Nghe An Friendship General Hospital

2019 ◽  
Vol 9 (4) ◽  
Author(s):  
Van Huong Nguyen ◽  
Keyword(s):  
Weight Loss ◽  
Sample Size ◽  
Heller Myotomy ◽  
Average Length ◽  
Operation Time ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Average Weight ◽  
Dor Fundoplication ◽  
Cross Sectional

Abstract Introduction: The aim of this study is to evaluate the outcomes, feasibility and safety of laparoscopic Heller – Dor method in treatment of esophageal achalasia or achalasia . Material and Methods: it’s a descriptive cross-sectional study. The patients diagnosed an achalasia and underwent laparoscopic Heller myotomy and Dor fundoplication from 2014 to July 2019 enrolled. Results: 12 patients diagnosed an achalasia were operated on by laparoscopic Heller myotomy and Dor fundoplication. Age mean 40.8 ± 4.2 (18 -65), male 58.3% and female 41.7%. 83.3% of patients have dysphagia, mean dysphagia time 12.8 ±5.2 (2-60) months, vomiting: 41.7% and weight loss: 100%, average weight loss was 6.7 ± 5.5 (3-15) kg ???.=> does not make sense ! X-ray with contrast of esophageal revealed bird beak sign: 41.7%, sigmoid form 16.7% normal or slight dilation 41.6%. ?? The average operation time was 138.8 ± 9,4 (77-180) mins. The complication occurred during the surgery (bleeding converted to open surgery). No other complications such as perforation occurred during and after the surgery. The average length of postoperative hospital stay was 7.5 ± 0.5 (5-11) days. Quality of life after surgery was very good and good in 83.3% and average 16.7%. Conclusion: Laparoscopic surgery in treatment of achalasia by Heller – Dor technique was safe and effective, with less postoperative pain, fast recovery and short hospital length stays. Almost patients satisfied with the results of this procedure. However, due to the sample size of this study is small so it is necessary to conduct other studies with larger sample size.

494 LONG-TERM SYMPTOM CONTROL FOLLOWING LAPAROSCOPIC HELLER MYOTOMY AND DOR FUNDOPLICATION FOR ACHALASIA

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
M Doubova ◽  
S Gowing ◽  
H Robaidi ◽  
S Gilbert ◽  
D Maziak ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Symptom Control ◽  
Laparoscopic Heller Myotomy ◽  
Dor Fundoplication ◽  
Esophageal Motility Disorder ◽  
Gerd Symptoms

Abstract   Achalasia is a primary esophageal motility disorder in which there is incomplete relaxation of the lower esophageal sphincter and absence of peristalsis in the lower two-thirds of the esophagus. A favored treatment is with laparoscopic modified Heller myotomy with Dor fundoplication (LHMDor) with over 90% beneficial effect. The short-term outcomes of LHMDor are well documented, but stability and durability of post-operative symptom control over time is less understood. Methods Between 2004–2016, 54 patients with achalasia underwent LHMDor (single center). Using validated questionnaires, patients rated their symptoms in five domains: pain, gastroesophageal reflux disease (GERD), dysphagia, regurgitation and quality of life (QOL), rating their symptoms preoperatively, 4-weeks post-operatively, 6-months post-operatively and yearly following the operation. Results As expected, patients reported marked improvement in dysphagia, odynophagia, regurgitation, GERD and quality of life after the operation (p < 0.001). From then on, the symptom control remained durable with respect to absence of pain, regurgitation and odynophagia; however, we observed a recurrence of GERD symptoms beginning 3–5 years postoperatively (p = 0.001, p = 0.04, respectively), with associated increased antacid use. Following initial LHMDor, 5 patients required endoscopic dilatation an average of 1.5 years post-operatively and no patient required reoperation. Patients reported preserved improved quality of life up to 11 years following the operation (p = 0.001). Conclusion These results demonstrate the durability of LHMDor in the definitive management of achalasia offering consistent symptomatic relief and significant improvement to QOL over the decade following surgery, despite some increase in GERD symptoms and antacid use.

scholarly journals Laparoscopic Heller Myotomy for Achalasia: Experience from a Single Referral Tertiary Center

2019 ◽  
Vol 11 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Alireza Mirsharifi ◽  
Ali Ghorbani Abdehgah ◽  
Rasoul Mirsharifi ◽  
Mehdi Jafari ◽  
Noor Fattah ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Cross Sectional Study ◽  
Laparoscopic Heller Myotomy ◽  
Partial Fundoplication ◽  
Dor Fundoplication ◽  
Esophageal Motility Disorder ◽  
Cross Sectional ◽  
Retrosternal Pain ◽  
Tertiary Center ◽  
The Mean

BACKGROUND Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. METHODS In this cross-sectional study all patients undergoing LHM between 2015 and 2017 were studied. The myotomy was followed by an anterior or posterior partial fundoplication. All patients were followed up for at least six months. RESULTS We conducted this prospective study on 36 consecutive patients who underwent LHM over 3 years. The mean age of the patients was 36.64 ± 13.47 years. 30 patients (83.3%) underwent Toupet and 6 patients (16.7%) received Dor fundoplication. 11 patients (30.6%) developed reflux after the procedure. According to the Eckardt Symptom Scoring (ESS), the symptoms improved in 74.2% of the patients and remained unchanged in 25.8% of the patients. Analysis of the ESS, indicated a significant change in regurgitation and retrosternal pain, dysphagia, and weight loss after the surgery (p = 0.001, p = 0.002, p = 0.046, and p = 0.001, respectively). CONCLUSION LHM with anterior or posterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia, especially in patients who have not responded to other methods while no serious complication was reported despite several prior endoscopic interventions.

Laparoscopic Heller Myotomy for Achalasia Technical Aspects

2018 ◽  
Vol 84 (4) ◽  
pp. 477-480 ◽  
Author(s):  
Francisco Schlottmann ◽  
Marco E. Allaix ◽  
Marco G. Patti
Keyword(s):  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Treatment Options ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Partial Fundoplication ◽  
Esophageal Peristalsis ◽  
Esophageal Motility Disorder ◽  
Esophageal Sphincter ◽  
Esophageal Emptying

Esophageal achalasia is a primary esophageal motility disorder defined by the lack of esophageal peristalsis, and by a lower esophageal sphincter that fails to relax in response to swallowing. Patients’ symptoms include dysphagia, regurgitation, aspiration, heartburn, and chest pain. Achalasia is a chronic condition without cure, and treatment options are aimed at providing symptomatic relief, improving esophageal emptying, and preventing the development of megaesophagus. Presently, a laparoscopic Heller myotomy with a partial fundoplication is considered the best treatment modality. A properly executed operation is key for the success of a laparoscopic Heller myotomy.

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