STUDY AIM: Aim of this study was to assess symptomatic and objective outcome in patients undergoing laparoscopic Heller myotomy after unsuccessful endoscopic treatment, compared to patients having primary surgery. PATIENTS AND METHOD: Between November 1992 and December 1998, 92 patients with esophageal achalasia underwent laparoscopic Heller myotomy and Dor fundoplication. Intraoperative endoscopy was routinely performed. Sixty patients had primary surgery (PS); 32 patients had surgery after unsuccessful pneumatic dilatation (PD) (n = 22), or botulinum toxin (Botox) injection (n = 10). RESULTS: The mean operative time and the incidence of postoperative dysphagia were similar in the two groups. The incidence of intraoperative mucosal tears was 5% in the PS group and 12.5% in the PD/Botox group (P = NS). Mucosal tears occurred more frequently during the first 30 operations (17% vs 3.2%, P < 0.05). Median follow-up was 28 months (range 4-76). An abnormal esophageal acid exposure was documented in 2 patients in the PS group (7.7%), and in two patients in the PD/Botox group (13.3%) (P = NS). Lower esophageal sphincter pressure significantly decreased in both groups (P < 0.01). The mean percentage of radionuclide residual activity in the esophagus at 1 and 10 minutes significantly decreased in both groups (P < 0.01). CONCLUSION: There is only a trend, although not statistically significant, towards an increased risk of complications and adverse effects in patients previously treated by PD and/or Botox. The higher incidence of mucosal tears during the first 30 operations suggests the effect of the learning curve.
STUDY AIM: Aim of this study was to assess symptomatic and objective outcome in patients undergoing laparoscopic Heller myotomy after unsuccessful endoscopic treatment, compared to patients having primary surgery. PATIENTS AND METHOD: Between November 1992 and December 1998, 92 patients with esophageal achalasia underwent laparoscopic Heller myotomy and Dor fundoplication. Intraoperative endoscopy was routinely performed. Sixty patients had primary surgery (PS); 32 patients had surgery after unsuccessful pneumatic dilatation (PD) (n = 22), or botulinum toxin (Botox) injection (n = 10). RESULTS: The mean operative time and the incidence of postoperative dysphagia were similar in the two groups. The incidence of intraoperative mucosal tears was 5% in the PS group and 12.5% in the PD/Botox group (P = NS). Mucosal tears occurred more frequently during the first 30 operations (17% vs 3.2%, P < 0.05). Median follow-up was 28 months (range 4-76). An abnormal esophageal acid exposure was documented in 2 patients in the PS group (7.7%), and in two patients in the PD/Botox group (13.3%) (P = NS). Lower esophageal sphincter pressure significantly decreased in both groups (P < 0.01). The mean percentage of radionuclide residual activity in the esophagus at 1 and 10 minutes significantly decreased in both groups (P < 0.01). CONCLUSION: There is only a trend, although not statistically significant, towards an increased risk of complications and adverse effects in patients previously treated by PD and/or Botox. The higher incidence of mucosal tears during the first 30 operations suggests the effect of the learning curve.
Authors: Dimitrios Stefanidis; William Richardson; Timothy M Farrell; Geoffrey P Kohn; Vedra Augenstein; Robert D Fanelli Journal: Surg Endosc Date: 2011-11-02 Impact factor: 4.584
Authors: Aleksandar Petar Simić; Nebojsa S Radovanović; Ognjan M Skrobić; Zoran J Raznatović; Predrag M Pesko Journal: J Gastrointest Surg Date: 2009-12-22 Impact factor: 3.452
Authors: Christopher W Snyder; Ryan C Burton; Lindsay E Brown; Manasi S Kakade; Kelly R Finan; Mary T Hawn Journal: J Gastrointest Surg Date: 2009-09-30 Impact factor: 3.452
Authors: Giovanni Zaninotto; Vito Annese; Mario Costantini; Alberto Del Genio; Michela Costantino; Magdalena Epifani; Giovanni Gatto; Vittorio D'onofrio; Luigi Benini; Sandro Contini; Daniela Molena; Giorgio Battaglia; Berardino Tardio; Angelo Andriulli; Ermanno Ancona Journal: Ann Surg Date: 2004-03 Impact factor: 12.969