THE SURGICAL TREATMENT OF ACHALASIA ON LAPAROSCOPIC HELLER MYOTOMY WITH DOR ANTIREFLUX PROCEDURE AT HUE CENTRAL HOSPITAL

2020 ◽  
pp. 97-102
Author(s):  
Dung Phan Dinh Tuan ◽  
Hung Dang Ngoc ◽  
Loc Le
Keyword(s):  
Heller Myotomy ◽  
Clinical Symptoms ◽  
Laparoscopic Heller Myotomy ◽  
Antireflux Procedure ◽  
Pneumatic Dilation ◽  
Motor Disorder ◽  
Eckardt Score ◽  
Esophageal Sphincter ◽  
Prospective Analyses

Background: Achalasia is a primary motor disorder of the esophagus characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Diagnosis is confirmed by clinical symptoms, endoscopic, radiographic and manometric. Although pneumatic dilation has a role in the treatment of achalasia, laparoscopic Heller myotomy is considered by many experts as the best treatment modality for most patients with newly diagnosed achalasia. Objective: To evaluate the efficacy and safety of laparoscopic Heller myotomy with Dor antireflux procedure. Patients and Methods: Prospective analyses of the patients of achalasia undergoing laparoscopic Heller myotomy with Dor antireflux procedure from 01/2012 to 06/2020. We evaluated the data according to outcome measures, characteristics and treatment results of achalasia after laparoscopic Heller myotomy with Dor antireflux procedure. Results: We found 11 patients with achalasia were diagnosed and treated by laparoscopic. 100% of the patients have dysphagia, weight loss; 81.8% have chest pain and regurgitation. Mean operative duration was 148 ± 21 minutes. There was no complications had found in our patients. Follow-up after 3 - 6 months by Eckardt score show that 90.9% had a good result, 01 patient with persistent symtomps (Eckardt score > 3) had to undergo a pneumatic dilation. Conclusion: The results of the laparoscopic Heller myotomy with Dor antireflux procedure were safe and effective. Keywwords: Achalasia, laparoscopic Heller myotomy, Dor antireflux procedure

scholarly journals Evaluation of Short-term Outcomes of Laparoscopic Heller Cardiomyotomy with Dor Fundoplication Versus Pneumatic Dilatation for Treatment of Achalasia

2020 ◽  
Author(s):  
Islam Khaled ◽  
Gad M. Behairy ◽  
Mohamed Saeed ◽  
Sara Abdulaziz ◽  
Leena S. Omar ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Pneumatic Dilatation ◽  
Pneumatic Dilation ◽  
Dor Fundoplication ◽  
Therapeutic Success ◽  
Esophageal Motility Disorder ◽  
Eckardt Score ◽  
Esophageal Sphincter ◽  
Dor’S Fundoplication

Abstract Background: Achalasia is a rare esophageal motility disorder of unknown cause. However, the best treatment modality for achalasia is controversial. Treatment consists of disruption of the lower esophageal sphincter, classically either by endoscopic pneumatic dilation or laparoscopic Heller’s myotomy combined with an anti-reflux procedure. The study aim was to compare laparoscopic Heller cardiomyotomy plus Dor Fundoplication with pneumatic dilatation for treatment of achalasia.Methods: In this interventional study, we included 50 adult patients diagnosed as having achalasia by performing either a barium study or by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter on esophageal manometry. The patients were randomly classified into two groups according to the intervention performed: pneumatic dilation or laparoscopic Heller’s cardiomyotomy with Dor’s fundoplication(LHCM). Follow-up evaluations were performed after 8 and 16 months.Results: In total, 50 patients with achalasia and an Eckardt symptom score > 3 were managed by two different interventions according to their groups.After 16 months of follow up the height of a barium-contrast column after 5 min was significantly lower in the LHCM group than in the pneumatic dilation group. There were no other statistically significant differences in the primary or secondary outcomes(Eckardt score, lower esophageal sphincter, and quality of life) between the two groups.Conclusion: After 16 months of follow-up, the rates of therapeutic success and number of complications were nearly similar between LHCM and pneumatic dilation. We conclude that either treatment is suitable as an initial treatment for achalasia.

Results of laparoscopic Heller myotomy and Dor fundoplication in treatment of achalasia

2018 ◽  
Vol 8 (4) ◽  
Author(s):  
Tieu Loan Quang Lam ◽  
Viet Trung Lam
Keyword(s):  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Motor Disorder ◽  
Dor Fundoplication ◽  
Digestive Surgery ◽  
Percentage Improvement ◽  
Surgery Department ◽  
Larger Sample

Abstract Introduction: Achalasia is a primary esophageal motor disorder, which is relatively rare. Patients usually start silently and detect late for months to years. Therefore, laparoscopic Heller myotomy is now considered the surgical procedure of choice for treating achalasia. Anti-reflux procedure usually performed by surgeons is a Dor procedure because of its many advantages, and it is easy to perform in laparoscopic surgery. Purpose: The objectives of this study is to determine the incidence and complications of laparoscopic Heller myotomy and Dor fundoplication and determine percentage improvement dysphagia after surgery. Material and Methods: Patients diagnosed achalasia and underwent laparoscopic Heller myotomy and Dor fundoplication at the Digestive Surgery Department of Cho Ray hospital from January 2011 to May 2017. Results: 23 patients with achalasia were operated on for laparoscopic Heller myotomy and Dor fundoplication. 95.7% of patient have dysphagia, regurgitation: 39.1%, and weight loss: 46%. The grade of patients with the highest diameter of the esophagus: 13.04% degree I, 52.18% degree II, 13.04% degree III, 21.74% degree IV. Average surgery time was 150.22 ± 35.63 minutes. Complication in surgery: esophageal perforation occurred in about 13.04% cases, there was 4.35% of bleeding reported. Quality of life after surgery was good and very good at 91.3%. Conclusion: The results of laparoscopic Heller myotomy and Dor fundoplication were effective, most patients satisfied the results of surgery. However, the size of this study is limited so it is necessary to follow up with other studies with larger sample size.

Management of Patients after Failed Peroral Endoscopic Myotomy: a Multicenter Study

Endoscopy ◽  
2020 ◽  
Author(s):  
Yervant Ichkhanian ◽  
Daniella Assis ◽  
Pietro Familiari ◽  
Michael B Ujiki ◽  
Baily Su ◽  
...  
Keyword(s):  
Clinical Success ◽  
Management Strategies ◽  
Laparoscopic Heller Myotomy ◽  
Peroral Endoscopic Myotomy ◽  
Pneumatic Dilation ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Excellent Safety Profile ◽  
International Multicenter

Background and Aims: Although Peroral Endoscopic Myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aims to compare the outcomes of different management strategies in patients who had failed POEM. Patients and Methods: This is an international, multicenter, retrospective study at 16 tertiary centers between 1/2012 and 11/2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score (ES) > 3) were included. The primary outcome was to compare the rate of clinical success (ES ≤ 3) between different management strategies. Results: A total of 99 patients (50 (50.5%) males, mean age 51.4 (16.2) yrs.) experienced clinical failure during the study period with a mean ES of 5.5 (0.2). A total of 29 (32.2%) patients were managed conservatively and 70 (71%) underwent re-treatment [repeat POEM 33 (33%), pneumatic dilation (PD) 30 (30%), and laparoscopic Heller myotomy (LHM) 7 (7.1%)]. During a median follow-up of 10 (IQR: 3-20) months, clinical success was highest in patients who underwent repeat POEM (25/33 (76%), mean ES 2.1 (2.1)), followed by PD (18/30 (60%), mean ES 2.8 (2.3)), and LHM (2/7 (29%), 4 (1.8)) (p=0.12). A total of 11 (37.9%, mean ES 4 (1.8)) patients in the conservative achieved clinical success. Conclusion: This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and PD achieved acceptable clinical success with excellent safety profile.

scholarly journals Revisional Therapy for Recurrent Symptoms After Heller Myotomy for Achalasia

2021 ◽  
Author(s):  
Pamela Milito ◽  
Stefano Siboni ◽  
Andrea Lovece ◽  
Erika Andreatta ◽  
Emanuele Asti ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Tertiary Care ◽  
Final Analysis ◽  
Esophageal Achalasia ◽  
University Hospital ◽  
Barium Swallow ◽  
Upper Gastrointestinal Endoscopy ◽  
Pneumatic Dilation ◽  
Eckardt Score

Abstract Purpose Symptom recurrence after initial surgical management of esophageal achalasia occurs in 10–25% of patients. The aim of this study was to analyze safety and efficacy of revisional therapy after failed Heller myotomy (HM). Methods A retrospective review of a prospective database was performed searching for patients with recurrent symptoms after primary surgical therapy for achalasia. Patients with previously failed HM were considered for the final analysis. The Foregut questionnaire, and the Atkinson and Eckardt scales were used to assess severity of symptoms. Objective investigations routinely included upper gastrointestinal endoscopy and barium swallow study. Redo treatments consisted of endoscopic pneumatic dilation (PD), laparoscopic HM, hybrid Ivor Lewis esophagectomy, or stapled cardioplasty. A yearly clinical and endoscopic follow-up was scheduled in all patients. Results Over a 20-year period, 26 patients with a median age of 66 years (IQR 19.5) underwent revisional therapy after failed HM for achalasia at a tertiary-care university hospital. The median time after index procedure was 10 years (IQR 21). Revisional therapy consisted of endoscopic pneumatic dilation (n=13), laparoscopic HM and fundoplication (n=10), esophagectomy (n=2), and stapled cardioplasty and fundoplication (n=1). Nine (34.6%) of these patients required further endoscopic or surgical treatments. There was no mortality, and the overall complication rate was 7.7%. At a median follow-up of 42 months (range 10–149), a significant decrease of dysphagia, regurgitation, chest pain, respiratory symptoms, and median Eckardt score (p<0.05) was noted. Conclusion In specialized and multidisciplinary centers, revisional therapy for achalasia is feasible, safe, and effective.

scholarly journals Efficacy and Durability of Laparoscopic Heller Myotomy: Patient Symptoms and Satisfaction at Long Term Follow up

2011 ◽  
Vol 140 (5) ◽  
pp. S-1015
Author(s):  
John G. Linn ◽  
Anthony N. Chan ◽  
Sarwat Ahmad ◽  
Peter Muscarella ◽  
W.S. Melvin ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Long Term Follow Up

Effects of Peroral Endoscopic Myotomy on Esophageal Function in the Treatment of Achalasia

2020 ◽  
pp. 155335062091313
Author(s):  
Bai Cang Zou ◽  
Li Zhang ◽  
Bin Qin ◽  
Shen Hao Wang ◽  
Yan Cheng ◽  
...  
Keyword(s):  
Stent Implantation ◽  
Clinical Symptoms ◽  
Operation Time ◽  
Peroral Endoscopic Myotomy ◽  
Esophageal Stent ◽  
Sphincter Pressure ◽  
Esophageal Function ◽  
Eckardt Score ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Peroral endoscopic myotomy (POEM) is a new technique to treat achalasia, but the effects on esophageal motor function and structure are still unclear. This study aimed to examine the esophageal function and anatomical changes of patients with achalasia treated with POEM. This was a retrospective study of 43 patients with achalasia treated with POEM between January 2013 and January 2016 at the Second Affiliated Hospital of Xi’an Jiaotong University. The patients were grouped as previous treatments for achalasia (n = 19) versus no previous treatment (n = 24). Surgical success (defined as Eckardt score ≤3 points or decreased by >3 points compared with baseline), recurrence, and reintervention were analyzed. Three patients (7.0%) were Eckardt grade I, 16 (37.2%) were grade II, and 24 (55.8%) were grade III. Operation time was 35 to 150 (median = 49) minutes. Both groups showed improvements in the Eckardt score after surgery (both P < .001), without a difference between the 2 groups ( P = .749). The maximal mean diameter of the esophagus was reduced, and the lower esophageal sphincter pressure was improved after surgery (both groups, all P < .001), without difference between the 2 groups (all P > .05). One case of failure was probably due to the presence of an esophageal stent. POEM has a high success rate and is possibly unaffected by previous treatments, except maybe stent implantation. Clinical symptoms of achalasia are significantly relieved by POEM; the function of the esophageal sphincter and the esophagus structure are improved. Previous esophageal stent implantation could increase failure likelihood, but this will have to be confirmed.

HP08�LONG TERM FOLLOW-UP OF LAPAROSCOPIC HELLER MYOTOMY FOR ACHALASIA

2009 ◽  
Vol 79 ◽  
pp. A40-A40
Author(s):  
K. M. Heggie ◽  
C. Pilgrim ◽  
W. Brown ◽  
J. Choi ◽  
A. Smith ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Long Term Follow Up

1 year follow up of Laparoscopic Heller myotomy in achalasia

2000 ◽  
Vol 118 (4) ◽  
pp. A1508
Author(s):  
Greg S. Cohen ◽  
Ikuo Hirano ◽  
Pamela Andersen ◽  
Michael A. Manka ◽  
Raymond J. Joehl ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy

scholarly journals Advances in the diagnosis and treatment of achalasia of the cardia: A review

2021 ◽  
Vol 9 (1) ◽  
pp. 24-31
Author(s):  
Baozhen Zhang ◽  
Yidan Wang ◽  
Ye Liao ◽  
Jingjing Zhang ◽  
Yufan Wu ◽  
...  
Keyword(s):  
Lower Esophageal Sphincter ◽  
Peroral Endoscopic Myotomy ◽  
Diagnosis And Treatment ◽  
Pneumatic Dilation ◽  
Motor Disorder ◽  
Sphincter Pressure ◽  
Idiopathic Achalasia ◽  
Retrosternal Pain ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Abstract Idiopathic achalasia is an esophageal motor disorder characterized by the loss of the lower esophageal sphincter ganglion, resulting in impaired lower esophageal relaxation and absence of esophageal peristalsis. Patients commonly present with progressive dysphagia accompanied by reflux, heartburn, retrosternal pain, and severe weight loss. Diagnosis is primarily based on the patient’s chief complaints, barium esophagography, and the most recent high-resolution manometry. Endoscopic assessment and endoscopic ultrasonography also have significant value with regard to the exclusion of esophageal anatomical lesions, neoplastic diseases, and pseudoachalasia. However, as most patients with achalasia demonstrate a gradual onset, early diagnosis is difficult. Currently, treatment of idiopathic achalasia, including pneumatic dilation, stent placement, and surgical myotomy, is aimed at reducing lower esophageal sphincter pressure and relieving the symptoms of dysphagia. Peroral endoscopic myotomy has gradually become the mainstream treatment because it causes less trauma and has a rapid recovery rate. This article reviews the main methods of diagnosis and treatment of achalasia, with an emphasis on the potential of peroral endoscopic myotomy and the advancements of immunotherapy for achalasia.

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