medigraphic.com
ISSN 0185-3252 (Print)
Revista de la Asociación Médica del Centro Médico ABC

2011, Number 2

<< Back Next >>

An Med Asoc Med Hosp ABC 2011; 56 (2)

Surgical management of achalasia in the ABC Medical Center

Wellman-Wollenstein R, Ortiz de la Peña-Rodríguez J, Hernandez-Peña R, Orozco-Obregón P, Decanini-Teran C, Herrera-Hernandez M, Quijano-Orvañanos F, Guzmán-Navarro L, Serrano-Berry F, Luque-De León E, Chousleb-Kalach A

Language: Spanish
References: 43
Page: 63-72
PDF size: 174.75 Kb.


ABSTRACT

Introduction: Achalasia is an infrequent disease of unknown etiology that is characterized by progressive dysphagia due to the lack of relaxation of the lower esophageal sphincter in response to swallowing. It does not have any preference for sex or age. Through the years it has been treated pharmacologically, with endoscopic balloon dilations and surgically. Although surgery has always proven to have the best results, other treatments are preferred because they are less invasive, but this has changed recently since the development of minimally invasive surgery, that has proved to have good results with fast recovery and less pain. Objectives: To review all achalasia cases in the ABC Medical Center since the first laparoscopic case in 1995. Materials and methods: Retrospective study reviewing files during an 11 year span. Results: 25 patients were included, 5 open and 20 laparoscopic, with a conversion rate of 10%. Postoperative dysphagia was 24% but ›90% of patients rated it as minor and were satisfied with their results. Mortality rate was 0% and morbidity 16%. Conclusions: Laparoscopic management of achalasia is safe and effective and must be considered a first line treatment before other non invasive alternatives.


REFERENCES

  1. Woltman TA, Pellegrini CA, Oelschlager BK. Achalasia. Surg Clin N Am 2005; 85: 483–493.

  2. Achem RS, DeVault RK. Dysphagia in aging. J Clin Gastroenterol 2005; 39 (5).

  3. Csendes A, Braghetto I, Hernriquez A et al. Late results of a prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia. Gut 1989; 30:299–304.

  4. Peters JH, DeMeester TR. Esophagus and diaphragmatic hernia. Schwartz’s Principles of Surgery. 8th ed. New York, NY: McGraw-Hill; 2005.

  5. Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW. Minimally invasive surgery for achalasia: An 8-year experience with 168 patients. Ann Surg 1999; 230 (4): 587-593.

  6. Ramacciato G, Mercantini P, Amodio PM, Corigliano N, Barreca M. The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit. Surg Endosc 2002; 16 (10): 1431-1437.

  7. Urbach DR, Hansen PD, Khajanchee YS, Swanstrom LL. A decision analysis of the optimal initial approach to achalasia: Laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection. J Gastrointest Surg 2001; 5 (2): 192-205.

  8. Frantzides CT, Moore RE, Carlson MA, Madan AK, Zografakis JG, Keshavarzian A. Minimally invasive surgery for achalasia: A 10-year experience. J Gastrointest Surg 2004; 8 (1): 18-23.

  9. Decanini TC, Varela GG, Galicia JA. Laparoscopic esophagomyotomy and antireflux procedure with intraoperative manometry. Surg Laparosc Endosc 1996; 6 (5): 398-402.

  10. Moreno-Portillo M, Pereira-Graterol F, Alvarado-Aparicio HA, Rojano-Rodríguez M, Herrera-Esquivel J. Esófago-cardiomiotomía laparoscópica para el tratamiento de la acalasia. Experiencia en un hospital mexicano. Rev Mex Cir Endosc 2004; 5 (1): 29-37.

  11. Aguirre RR, Castañeda CP, Valladares LMA, Díaz RF, Alonso PM. Tratamiento quirúrgico de la acalasia mediante laparoscopia. Cir Gen 2000; 22 (1).

  12. Covarrubias MA, López-Corvalá JA, Guzmán CF, Jaramillo EJ, Solórzano EA, Barrera LM, Cardiomiotomía de Heller con abordaje laparoscópico: Experiencia del HGR No. 1, IMSS, Tijuana. Rev Mex Cir Endoscop 2007; 8 (1): 30-34.

  13. Bonatti H, Hinder RA, Klocker J, Neuhauser B, Klaus A, Achem SR, De Vault K. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg 2005; 190: 874–878.

  14. Bloomston M, Durkin A, Boyce HW, Johnson M, Rosemurgy AS. Early results of laparoscopic Heller myotomy do not necessarily predict long-term outcome. Am J Surg 2004; 187: 403–407.

  15. Zundel N, Chousleb E, Arias F, Roversi MA et al Estado actual de la cirugía de mínima invasión en el tratamiento de la acalasia. Rev Mex Cir Endoscop 2003; 4 (4): 173-177.

  16. Willis T. In: Hagae Comitis. Pharmaceutice rationalis sive diatribe de medicamentorum operationibus in human corpore. London: 1674.

  17. Heller E. Extramukose kerkioplastic beim chronischen kardiospasmus mit dilatation des oesophagus. Mitt Grenzgeb Med Chir 1914; 27: 141-149.

  18. Zaaijer JH. Cardiospasm in the aged. Ann Surg 1923; 77: 615-617.

  19. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. JR Coll Surg Edinb 1991; 36 (3): 152-154.

  20. Pellegrini CA, Wetter LA, Patti M, Leichter R, Mussan G, Mori T, Bernstein G, Way L. Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg 1992; 216 (3): 291-296.

  21. Goyal RK. Disorders of the Alimentary Tract, Diseases of the Esophagus. Harrison´s Principles of Internal Medicine. 16th ed. 2005.

  22. Patti MG, Tedesco P, Way LW. Esophagus and diaphragm. Current Surgical Diagnosis & Treatment. 12th ed. New York, NY: McGraw-Hill; 2006.

  23. Kongara K, Soffer E. Esophageal Motility Disorders & Noncardiac Chest Pain. Current Diagnosis and Treatment in Gastroenerology. 2nd ed. New York, NY: McGraw-Hill; 2003.

  24. Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, Gantert W, Way LW. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci 1999; 44 (11): 2270-2276.

  25. Rajiv Bansal R, Nostrant TT, Scheiman JM, Koshy S, Barnett JL, Elta GH, Chey WD. Intrasphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia. J Clin Gastroenterol 2003; 36 (3): 209–214.

  26. Bloomston M, Serafini F, Rosemurgy AS. Videoscopic heller myotomy as first-line therapy for severe achalasia. Am Surg 2001; 67 (11): 1105-1109.

  27. Bonavina L, Incarbone R, Antoniazzi L, Reitano M, Peracchia A. Previous endoscopic treatment does not affect complication rate and outcome of laparoscopic Heller myotomy and anterior fundoplication for oesophageal achalasia. Ital J Gastroenterol Hepatol 1999; 31 (9): 827-830.

  28. Guardino MJ, Vela FM, Connor TJ, Richter EJ. Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed heller myotomy. J Clin Gastroenterol 2004; 38 (10).

  29. Harold KL, Matthews BD, Kercher KW, Sing RF, Heniford TB. Surgical treatment of achalasia in the 21st Century. South Med J 2004; 97 (1).

  30. Jeansonne LO, White BC, Pilger KE, Shane MD, Zagorski S, Davis SS, Hunter JG, Lin E, Smith CD. Ten year follow-up of laparoscopic Heller myotomy for achalasia shows durability. Surg Endosc 2007; Jul 11.

  31. Katada N, Sakuramoto S, Kobayashi N, Futawatari N, Kuroyama S. Laparoscopic Heller myotomy with Toupet fundoplication for achalasia straightens the esophagus and relieves dysphagia. Am J Surg 2006; 192: 1–8.

  32. Tsiaoussis J, Athanasakis E, Pechlivanides G, Tzortzinis A, Gouvas N. Long-term functional results after laparoscopic surgery for esophageal achalasia. Am J Surg 2007; 193: 26–33.

  33. Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henrýquez A. Very late results of esophagomyotomy for patients with achalasia. Ann Surg 2006; 243 (2).

  34. Maher JW, Conklin J, Heitshusen DS. Thoracoscopic esophagomyotomy for achalasia: Preoperative patterns of acid reflux and long-term follow-up. Surgery 2001; 130: 570-577.

  35. Raiser F, Perdikis G, Hinder RA, Swanstrom LL, Filipi CJ, McBride PJ, Katada N, Neary PJ. Heller myotomy via minimal-access surgery. An evaluation of antireflux procedures. Arch Surg 1996; 131 (6): 593-597.

  36. Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003; 138: 490–497.

  37. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: A prospective randomized double-blind clinical trial. Ann Surg 2005; 241 (6): 1029.

  38. Rice TW, McKelvey AA, Richter JE, Baker ME, Vaezi MF, Feng J, Murthy SC, Mason DP, Blackstone EH. A physiologic clinical study of achalasia: Should Dor fundoplication be added to Heller myotomy? J Thorac Cardiovasc Surg 2005; 130 (6): 1593-600.

  39. Wills VL, Hunt DR. Functional outcome after Heller myotomy and fundoplication for achalasia. J Gastrointest Surg 2001; 5: 408–13.

  40. Rossetti G, Brusciano L, Amato G, Maffettone V, Napolitano V, Russo G, Izzo D, Russo F, Pizza F, Del Genio G, Del Genio A. A total fundoplication is not an obstacle to esophageal emptying after Heller myotomy for achalasia: results of a long-term follow up. Ann Surg 2005; 241 (4): 614-621.

  41. Wang QS, Liu L, Dong L, Shen ZL, Zhou DH, Hu CX. Laparoscopic Heller-Dor operation for patients with achalasia. Chin Med J (Engl) 2006; 119 (6): 443-448.

  42. Csendes JA, Burdiles PP, Korn BO, Braghetto MI, Díaz JJC, Henríquez DA. Resultados preliminares de la esofagomiotomía por videolaparoscopia en pacientes con acalasia esofágica. Rev Med Chile 2001; 129 (10).

  43. Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, Gatto G. Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg 2004; 239: 364–370.




2020     |     www.medigraphic.com