Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia
| Autor: | Brant K. Oelschlager, Carlos A. Pellegrini, Andrew S. Wright, C. W. Williams |
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| Rok vydání: | 2006 |
| Předmět: |
Myotomy
Adult Male Reoperation medicine.medical_specialty Gastrointestinal Diseases Manometry medicine.medical_treatment Achalasia Fundoplication Severity of Illness Index Esophagus Recurrence Severity of illness otorhinolaryngologic diseases medicine Humans Longitudinal Studies Postoperative Period Digestive System Surgical Procedures Heller myotomy Esophageal disease business.industry Heartburn Middle Aged medicine.disease Dysphagia Surgery Esophageal Achalasia medicine.anatomical_structure Treatment Outcome Female medicine.symptom business Deglutition Disorders |
| Zdroj: | Surgical endoscopy. 21(5) |
| ISSN: | 1432-2218 |
| Popis: | The standard Heller myotomy (SM) for achalasia extends 1 to 2 cm on to the stomach. The authors perform an extended myotomy (EM) (3 cm) with the goal of reducing postoperative dysphagia. This study examines the long-term efficacy and durability of EM compared with SM.Patients with achalasia who underwent a laparoscopic Heller myotomy were identified from a prospective database that includes symptom evaluation and results of esophageal functional studies. From September 1994 to August 1998, the authors performed SM with Dor fundoplication, and from September 1998 through 2003, they performed EM with Toupet fundoplication. In 2001, they performed a telephone survey of all available patients. This was repeated in 2005 for the EM group. The survey included scales of symptom frequency (0 [never], 1 [once per month], 2 [once per week], 3 [once per day], 4 [more than once per day]) and severity (0 [no symptoms] to 10 [symptoms equal to preoperative state]) as well as the need to undergo postoperative intervention for dysphagia.For this study, 52 patients underwent SM with Dor fundoplication (median follow-up period, 46 +/- 24 months), and 63 patients underwent EM with Toupet fundoplication (median follow-up period, 45 +/- 17 months. Postoperative dysphagia severity was significantly better in the EM group (4.8 +/- 2.3 vs 3.1 +/- 2.6; p0.005). There was no significant difference in postoperative heartburn frequency, esophageal acid exposure, or lower esophageal sphincter pressure. In the SM group, 9 patients (17%) required reintervention for dysphagia: 14 endoscopic interventions for 5 patients (10%) and reoperation for 4 patients. Three patients (5%) in the EM group required reintervention for dysphagia: one endoscopic intervention each and no reoperations (p0.05). A total of 30 patients in the EM group were contacted in both 2001 (median follow-up period, 19 +/- 11 months) and 2005 (median follow-up period, 63 +/- 10 months). There was no significant change over time in dysphagia severity (2.6 +/- 1.9 vs 3.7 +/- 2.0; p = 0.19).For the treatment of achalasia, EM with Toupet fundoplication provides excellent durable dysphagia relief that is superior to SM with Dor fundoplication. |
| Databáze: | OpenAIRE |
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