Reintervention After Heller Myotomy for Achalasia: Is It Inevitable?
| Autor: | Sudish C. Murthy, Rocio Lopez, Thomas W. Rice, Scott Gabbard, Monica Ray, Lucy Thuita, Prashanthi N. Thota, Neha Wadhwa, Dean P. Schraufnagel, Siva Raja, Andrea Zanoni, Eugene H. Blackstone, Madhu R. Sanaka |
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| Rok vydání: | 2018 |
| Předmět: |
Pulmonary and Respiratory Medicine
Myotomy Male Reoperation medicine.medical_specialty Manometry medicine.medical_treatment Treatment outcome Achalasia Heller Myotomy 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Esophagus Pressure Medicine Humans Retrospective Studies Heller myotomy business.industry Follow up studies Retrospective cohort study Therapeutic decision making Middle Aged medicine.disease Surgery Esophageal Achalasia Esophagus surgery Treatment Outcome 030228 respiratory system Female Esophagoscopy Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | The Annals of thoracic surgery. 107(3) |
| ISSN: | 1552-6259 |
| Popis: | Background Few studies of reintervention after Heller myotomy for achalasia set patients' expectations, assist therapeutic decision making, and direct follow-up. Therefore, we investigated the frequency and type of symptoms and reinterventions after myotomy based on achalasia type. Methods From January 2006 to March 2013, 248 patients who had preoperative high-resolution manometry and a timed barium esophagram (TBE) underwent Heller myotomy, 62 (25%) for type I, 162 (65%) for type II, and 24 (10%) for type III achalasia. Postoperative surveillance, including TBE, was performed at 8 weeks, then annually. Median follow-up was 36 months. End points were all symptom types and modes of reintervention, endoscopic or surgical. Reintervention was based on both symptoms and objective TBE measurements. Results Eventually most patients (169 of 218; 69%) experienced at least one symptom after myotomy. Fifty patients underwent 85 reinterventions, 41 endoscopic only, 4 surgical only, and 5 both. Five-year freedom from reintervention was 62% for type I, 74% for type II, and 87% for type III, most occurring within 6 months, although later in type III. At 5 years, number of reinterventions per 100 patients was 72 for type I, 51 for type II, and 13 for type III. After each reintervention, there was approximately a 50% chance of another within 2 years. Conclusions Patients' expectations when undergoing Heller myotomy for achalasia must be that symptoms will only be palliated, and patients who have worse esophageal function—achalasia type I—may require one or more postoperative reinterventions. Thus, we recommend that patients with achalasia have lifelong annual surveillance after Heller myotomy that includes TBE. |
| Databáze: | OpenAIRE |
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