PURPOSE: To define the factors predisposing to recurrence and evaluate the results of reoperations for achalasia. METHODS: We reviewed the medical records of ten patients (4 men and 6 women; mean age, 51.5 ± 11.0 years), who underwent reoperations for achalasia between August 1994 and August 2010. RESULTS: The primary surgical procedures were Heller-Dor (HD) cardioplasty in nine patients and Heller myotomy in one patient. The factors contributing to failure of the primary operation included inadequate myotomy (n = 2), recurrent adhesion after myotomy (n = 2), reflux esophagitis (n = 2), difficulty in passage caused by tortuosity of the esophagus (n = 2), difficulty in passage through the thoracic esophagus (n = 1), and severe chest pain (n = 1). The reoperations included repeated HD procedures (n = 4), repair of an esophageal hiatal hernia (n = 2), thoracic esophageal myotomy (n = 2), straightening of the lower esophagus with gastropexy (n = 1), and subtotal esophagectomy (n = 1). The success rate of the reoperations for resolving symptoms was 90 % (9 patients). CONCLUSION: Selecting surgical procedures based on the causes and conditions of recurrence led to symptomatic improvement and acceptable outcomes.
PURPOSE: To define the factors predisposing to recurrence and evaluate the results of reoperations for achalasia. METHODS: We reviewed the medical records of ten patients (4 men and 6 women; mean age, 51.5 ± 11.0 years), who underwent reoperations for achalasia between August 1994 and August 2010. RESULTS: The primary surgical procedures were Heller-Dor (HD) cardioplasty in nine patients and Heller myotomy in one patient. The factors contributing to failure of the primary operation included inadequate myotomy (n = 2), recurrent adhesion after myotomy (n = 2), reflux esophagitis (n = 2), difficulty in passage caused by tortuosity of the esophagus (n = 2), difficulty in passage through the thoracic esophagus (n = 1), and severe chest pain (n = 1). The reoperations included repeated HD procedures (n = 4), repair of an esophageal hiatal hernia (n = 2), thoracic esophageal myotomy (n = 2), straightening of the lower esophagus with gastropexy (n = 1), and subtotal esophagectomy (n = 1). The success rate of the reoperations for resolving symptoms was 90 % (9 patients). CONCLUSION: Selecting surgical procedures based on the causes and conditions of recurrence led to symptomatic improvement and acceptable outcomes.
Authors: Brechtje A Grotenhuis; Bas P L Wijnhoven; Jennifer C Myers; Glyn G Jamieson; Peter G Devitt; David I Watson Journal: Am J Surg Date: 2007-11 Impact factor: 2.565
Authors: Ines Gockel; Stephan Timm; George G Sgourakis; Thomas J Musholt; Andreas D Rink; Hauke Lang Journal: J Gastrointest Surg Date: 2009-10-24 Impact factor: 3.452
Authors: Sarah M Cowgill; Desiree Villadolid; Robert Boyle; Sam Al-Saadi; Sharona Ross; Alexander S Rosemurgy Journal: Surg Endosc Date: 2009-06-24 Impact factor: 4.584