BACKGROUND: Extramucosal myotomy of the lower esophagus and cardia, combined with anterior fundoplication, is, in our opinion, the procedure of choice to treat stage I-III esophageal achalasia. METHODS: After a successful experience with open surgery in over 280 patients, from January 1992 through February 1997, 61 patients underwent laparoscopic Heller-Dor for stage I-III achalasia. Conversion to laparotomy was done in three cases. All procedures were performed under intraoperative endoscopic control. Intraoperative complications were seven mucosal tears, which were sutured laparoscopically in five cases. The sole postoperative complication was bleeding from an acute gastric ulcer (conservative treatment). RESULTS: Follow-up consisted of clinical and radiographic study 1 month after surgery, and endoscopy and manometry within 1 year. After a mean follow-up (F.U.) of 21 months (1-62), clinical results range from excellent to good in 98.2%. One patient (1.7%) complaining of recurrent dysphagia improved after endoscopic dilation. Esophageal diameter reduced from 52 to 27 mm. LES pressure reduced from 30.3 +/- 12.4 to 10.7 +/- 3.5 mmHg (basal) and from 14. 8 +/- 9.3 to 2.9 +/- 2.1 mmHg (residual). CONCLUSIONS: Laparoscopic Heller-Dor operation is feasible, safe, and effective. Special care should be taken in patients with previous endoscopic dilations.
BACKGROUND: Extramucosal myotomy of the lower esophagus and cardia, combined with anterior fundoplication, is, in our opinion, the procedure of choice to treat stage I-III esophageal achalasia. METHODS: After a successful experience with open surgery in over 280 patients, from January 1992 through February 1997, 61 patients underwent laparoscopic Heller-Dor for stage I-III achalasia. Conversion to laparotomy was done in three cases. All procedures were performed under intraoperative endoscopic control. Intraoperative complications were seven mucosal tears, which were sutured laparoscopically in five cases. The sole postoperative complication was bleeding from an acute gastric ulcer (conservative treatment). RESULTS: Follow-up consisted of clinical and radiographic study 1 month after surgery, and endoscopy and manometry within 1 year. After a mean follow-up (F.U.) of 21 months (1-62), clinical results range from excellent to good in 98.2%. One patient (1.7%) complaining of recurrent dysphagia improved after endoscopic dilation. Esophageal diameter reduced from 52 to 27 mm. LES pressure reduced from 30.3 +/- 12.4 to 10.7 +/- 3.5 mmHg (basal) and from 14. 8 +/- 9.3 to 2.9 +/- 2.1 mmHg (residual). CONCLUSIONS: Laparoscopic Heller-Dor operation is feasible, safe, and effective. Special care should be taken in patients with previous endoscopic dilations.
Authors: J L M C Azevedo; F O Kozu; O Azevedo; C E P Silva; A A Sorbello; M d J Simões; A Delorenzo; R C Pasqualin; G S Aguiar; F J C Menezes Journal: Surg Endosc Date: 2005-08-04 Impact factor: 4.584
Authors: M Costantini; G Zaninotto; E Guirroli; C Rizzetto; G Portale; A Ruol; L Nicoletti; E Ancona Journal: Surg Endosc Date: 2005-01-10 Impact factor: 4.584
Authors: N Omura; H Kashiwagi; Y Ishibashi; F Yano; K Tsuboi; N Kawasaki; Y Suzuki; K Yanaga Journal: Surg Endosc Date: 2005-11-21 Impact factor: 4.584
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