M G Patti1, C Galvani, M V Gorodner, P Tedesco. 1. Department of Surgery and Swallowing Center, University of California, San Francisco, 533 Parnassus Avenue, Room U-122, San Francisco, CA 94143-0788, USA. pattim@surgery.ucsf.edu
Abstract
BACKGROUND: It has been suggested that abnormal function of the lower esophageal sphincter is the primary abnormality in esophageal achalasia, and that the absence of esophageal peristalsis is secondary to the outflow obstruction caused by the lower esophageal sphincter. Furthermore, it has been proposed that early elimination of the resistance at the level of the gastroesophageal junction by surgical intervention could result in return of esophageal peristalsis. This study aimed to assess whether the timing of surgical intervention affects the return of esophageal peristalsis and the clinical outcome for patients with achalasia. METHODS: Between January 1991 and May 2003, 173 patients underwent a Heller myotomy by minimally invasive surgery for treatment of esophageal achalasia. Of these patients, 41 (24%) had pre- and postoperative esophageal manometry. These patients were divided into three groups based on the duration of symptoms: group A (10 patients; duration of symptoms 12 months group B (19 patients, duration of symptoms 12 to 60 months), and group C (12 patients; duration of symptoms longer than 60 months). RESULTS: The average duration of symptoms (dysphagia was present in all patients) was as follows: group A (8 +/- 4 months), group B, (35 +/- 16 months), and group C, (157 +/- 94 months). Vigorous achalasia was present in 40%, 21%, and 17% of the groups respectively. The differences between the groups were not significant. Postoperatively, improvement in esophageal motility was seen in no patient in group A, 1 patient (5%) in group B, and 1 patient (8%) in group C. Excellent or good results were obtained for 90% of the group A patients, 95% of group B patients, and 92% of the group C patients. Again, the differences were not significant. CONCLUSIONS: The results show that: a) the presence of vigorous achalasia is independent of symptoms duration; b) the timing of surgical intervention does not influence the return of peristalsis; and c) the results of a Heller myotomy are independent of symptoms duration.
BACKGROUND: It has been suggested that abnormal function of the lower esophageal sphincter is the primary abnormality in esophageal achalasia, and that the absence of esophageal peristalsis is secondary to the outflow obstruction caused by the lower esophageal sphincter. Furthermore, it has been proposed that early elimination of the resistance at the level of the gastroesophageal junction by surgical intervention could result in return of esophageal peristalsis. This study aimed to assess whether the timing of surgical intervention affects the return of esophageal peristalsis and the clinical outcome for patients with achalasia. METHODS: Between January 1991 and May 2003, 173 patients underwent a Heller myotomy by minimally invasive surgery for treatment of esophageal achalasia. Of these patients, 41 (24%) had pre- and postoperative esophageal manometry. These patients were divided into three groups based on the duration of symptoms: group A (10 patients; duration of symptoms 12 months group B (19 patients, duration of symptoms 12 to 60 months), and group C (12 patients; duration of symptoms longer than 60 months). RESULTS: The average duration of symptoms (dysphagia was present in all patients) was as follows: group A (8 +/- 4 months), group B, (35 +/- 16 months), and group C, (157 +/- 94 months). Vigorous achalasia was present in 40%, 21%, and 17% of the groups respectively. The differences between the groups were not significant. Postoperatively, improvement in esophageal motility was seen in no patient in group A, 1 patient (5%) in group B, and 1 patient (8%) in group C. Excellent or good results were obtained for 90% of the group A patients, 95% of group B patients, and 92% of the group C patients. Again, the differences were not significant. CONCLUSIONS: The results show that: a) the presence of vigorous achalasia is independent of symptoms duration; b) the timing of surgical intervention does not influence the return of peristalsis; and c) the results of a Heller myotomy are independent of symptoms duration.
Authors: Silvana Perretta; Piero M Fisichella; Carlos Galvani; Maria V Gorodner; Lawrence W Way; Marco G Patti Journal: J Gastrointest Surg Date: 2003 Jul-Aug Impact factor: 3.452
Authors: Sabine Roman; Peter J Kahrilas; François Mion; Thomas B Nealis; Nathaniel J Soper; Gilles Poncet; Frédéric Nicodème; Eric Hungness; John E Pandolfino Journal: JAMA Surg Date: 2013-02 Impact factor: 14.766
Authors: Roger P Tatum; Jamie A Wong; Edgar J Figueredo; Valeria Martin; Brant K Oelschlager Journal: J Gastrointest Surg Date: 2007-09-05 Impact factor: 3.452
Authors: Zuzana Vackova; Jan Mares; Jana Krajciova; Zuzana Rabekova; Lucie Zdrhova; Pavla Loudova; Julius Spicak; Petr Stirand; Tomas Hucl; Jan Martinek Journal: J Neurogastroenterol Motil Date: 2021-04-30 Impact factor: 4.924