| Autor: |
Peillon, Christophe, Fromont, Gérard, Auvray, Sylvain, Siriser, Frank |
| Zdroj: |
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques; April 2001, Vol. 11 Issue: 2 p71-75, 5p |
| Abstrakt: |
Laparoscopic Heller myotomy offers the best-known surgical therapy for esophageal achalasia. Nevertheless, this procedure continues to compete with alternative endoscopic treatment and is often considered only as a secondary resort. In this study, the authors performed a review of the results of laparoscopic Heller myotomy and an evaluation of the impact of previous endoscopic treatment regarding perioperative complications and late results. Twenty-seven patients with achalasia confirmed by a manometry examination underwent a primary laparoscopic Heller myotomy (group 1, n 14) or experienced endoscopic treatment failure (group 2, n 13). A dysphagia score (0–4) was obtained before and after surgery. Clinical course was reviewed at 2 months and then every 6 months after surgery. In December 1999, patients answered a questionnaire regarding surgery satisfaction, postoperative reflux, and dysphagia for statistical analysis. There were no deaths. Mean hospital stay was 5.6 days. Three perforations occurred in group 2 (25) versus one in group 1 (6) (not statistically significant). At a mean 27-month follow-up, the dysphagia score was significantly (P< 0.001) improved in both groups but more significantly in group 1 versus group 2 (not statistically significant). Only one patient in group 2 reported heartburn. All patients in group 1 (100) were satisfied with surgery as opposed to 10 of 13 patients (75) in group 2 (P< 0.10). Primary laparoscopic Heller myotomy appears to be the treatment of choice for achalasia. Previous endoscopic treatment increases intraoperative complications and may affect long-term results. |
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