Laparoscopic treatment of achalasia in a low prevalence healthcare setting
Keywords:
ESOPHAGEAL ACHALASIA, LAPAROSCOPYAbstract
Introduction: laparoscopic treatment of esophageal achalasia provides excellent functional results in the short and long term. In Uruguay the number of patients operated annually is low given demographic reasons and the low prevalence of the condition.
Objective: to analyse the results of the surgical treatment of achalasia by means of a video-assisted laparoscopic approach.
Method: retrospective, descriptive, observational study of a series of cases consisting of all patients operated at the Surgical Clinic 3 of the Maciel Hospital within a 108 month period (from 2002 through 2010), during which 17 patients underwent surgery (14 women, 3 men, average age: 34 years old), after an average of 24 months with symptoms, meeting the clinical, endoscopic, radiological and manometric criteria to diagnose achalasia and who were treated with esophagectomy associated to an antireflux Toupet procedure.
Results: surgical time was 120 minutes. There was no need to turn into laparotomy. One intraoperative mucous membrane perforation took place. Mortality was null. Functional results were excellent. Average follow-up: two years.
Conclusions: laparoscopic treatment of achalasia is a safe, effective and comfortable alternative that may be performed in our country with functional results that match the low morbility and no mortality international literature.
References
(1) Hurst AF. Modern technique in treatment: a series of special articles, contributed by invitation, on the treatment of medical and surgical conditions. The treatment of achalasia of the cardia (so-called cardiospasm). Lancet 1927; 209(5403):618-9.
(2) Williams VA, Peters JH. Achalasia of the esophagus: a surgical disease. J Am Coll Surg 2009; 208(1):151-62.
(3) Mayberry JF. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am 2001; 11(2):235-48.
(4) Pinotti HW, Nasi A, Domene CD, Santo MA, Telles Libanori H. Tratamiento laparoscópico de la acalasia esofágica. Disponible en: http://www.cirugest.com/htm/revisiones/cir01-07/cap31.pdf Consulta: 14 de junio de 2012.
(5) Universidad de la República. Facultad de Medicina. Departamento de Parasitología y Micología. Sección Chagas. Enfermedad de Chagas. Montevideo: de Parasitología y Micología. Sección Chagas, 2007. Disponible en: http://www.smu.org.uy/dpmc/hmed/historia/articulos/chagas.pdf Consulta: 14 de junio de 2012.
(6) Heller F. Extramukose kardiaplastik bein chronischen kardiospasms nut dilatation des oesophagus. Mett Grensgeb Med Chir 1914; 27:141-29.
(7) Zaaijer JH. Cardiospasm in the aged. Ann Surg 1923; 77(5):615-7.
(8) Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 2004; 240(3):405-12.
(9) Rice TW, McKelvey AA, Richter JE, Baker ME, Vaezi MF, Feng J, et al. A physiologic clinical study of achalasia: should Dor fundoplication be added to Heller myotomy? J Thorac Cardiovasc Surg 2005; 130(6):1593-600.
(10) Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg 2004; 239(3):364-70.
(11) Csendes A, Velasco N, Braghetto I, Henriquez A. A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology 1981; 80(4):789-95.
(12) Csendes A, Braghetto I, Henríquez A, Cortés C. Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut 1989; 30(3):299-304.
(13) Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henríquez A. Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg 2006; 243(2):196-203.
(14) Kostic S, Kjellin A, Ruth M, Lönroth H, Johnsson E, Andersson M, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg 2007; 31(3):470-8.
(15) Annese V, Bassotti G, Coccia G, Dinelli M, D'Onofrio V, Gatto G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 2000; 46(5):597-600.
(16) Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2):205-13.
(17) Visick AH. A study of the failures after gastrectomy. Ann R Coll Surg Engl 1948; 3(5):266-84.
(18) Praderi LA, Balboa O, Ricciardi N. Megaesófago, acalasia: nuestra experiencia. Cir Urug 1982; 52(4):323-33.
(19) Perrier JP, Fernández M, Sosa MC. Tratamiento quirúrgico de la acalasia y la opción de la cirugía laparoscópica. Cir Urug 2000; 70(1):36-44.
(20) Rodríguez G, Fernández G, Gatti A, Balboa O. Cirugía del hiato esofágico: abordaje video laparoscópico. Cir Urug 2003; 73(1):68-91.
(21) Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc 2007; 21(5):713-8.
(22) Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003; 138(5):490-5; discussion 495-7.
(23) Ellis FH Jr, Crozier RE, Gibb SP. Reoperative achalasia surgery. J Thorac Cardiovasc Surg 1986; 92(5):859-65. Erratum in: J Thorac Cardiovasc Surg 1987; 93(4):559.
(24) Malthaner RA, Tood TR, Miller L, Pearson FG. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg 1994; 58(5):1343-6; discussion 1346-7.
(25) Dor J, Humbert P, Dor V, Figarella J. L'interet de la technique de Nissen modifiee dans la prevention de reflux apres cardiomyotomie extramuqueuse de Heller. Mem Acad Chir (Paris) 1962; 88:877-83.
(26) Bonavina L, Nosadini A, Bardini R, Baessato M, Peracchia A. Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. Arch Surg 1992; 127(2):222-6.
(27) Zhu ZJ, Chen LQ, Duranceau A. Long-term result of total versus partial fundoplication after esophagomyotomy for primary esophageal motor disorders. World J Surg 2008; 32(3):401-7.
(28) Donahue PE, Schlesinger PK, Sluss KF, Richter HM, Liu KJ, Rypins EB, et al. Esophagocardiomyotomy-floppy Nissen fundoplication effectively treats achalasia without causing esophageal obstruction. Surgery 1994; 116(4):719-24.
(29) Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor undoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 2008; 248(6):1023-30.
(30) Orringer MB, Stirling MC. Esophageal resection for achalasia: indications and results. Ann Thorac Surg 1989; 47(3):340-5.
(31) Pinotti HW, Cecconello I, da Rocha JM, Zilberstein B. Resection for achalasia of the esophagus. Hepatogastroenterology 1991; 38(6):470-3.
(32) Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 1999; 230(4):587-93.
(33) Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 2008; 12(1):159-65.
(2) Williams VA, Peters JH. Achalasia of the esophagus: a surgical disease. J Am Coll Surg 2009; 208(1):151-62.
(3) Mayberry JF. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am 2001; 11(2):235-48.
(4) Pinotti HW, Nasi A, Domene CD, Santo MA, Telles Libanori H. Tratamiento laparoscópico de la acalasia esofágica. Disponible en: http://www.cirugest.com/htm/revisiones/cir01-07/cap31.pdf Consulta: 14 de junio de 2012.
(5) Universidad de la República. Facultad de Medicina. Departamento de Parasitología y Micología. Sección Chagas. Enfermedad de Chagas. Montevideo: de Parasitología y Micología. Sección Chagas, 2007. Disponible en: http://www.smu.org.uy/dpmc/hmed/historia/articulos/chagas.pdf Consulta: 14 de junio de 2012.
(6) Heller F. Extramukose kardiaplastik bein chronischen kardiospasms nut dilatation des oesophagus. Mett Grensgeb Med Chir 1914; 27:141-29.
(7) Zaaijer JH. Cardiospasm in the aged. Ann Surg 1923; 77(5):615-7.
(8) Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 2004; 240(3):405-12.
(9) Rice TW, McKelvey AA, Richter JE, Baker ME, Vaezi MF, Feng J, et al. A physiologic clinical study of achalasia: should Dor fundoplication be added to Heller myotomy? J Thorac Cardiovasc Surg 2005; 130(6):1593-600.
(10) Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg 2004; 239(3):364-70.
(11) Csendes A, Velasco N, Braghetto I, Henriquez A. A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology 1981; 80(4):789-95.
(12) Csendes A, Braghetto I, Henríquez A, Cortés C. Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut 1989; 30(3):299-304.
(13) Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henríquez A. Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg 2006; 243(2):196-203.
(14) Kostic S, Kjellin A, Ruth M, Lönroth H, Johnsson E, Andersson M, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg 2007; 31(3):470-8.
(15) Annese V, Bassotti G, Coccia G, Dinelli M, D'Onofrio V, Gatto G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 2000; 46(5):597-600.
(16) Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2):205-13.
(17) Visick AH. A study of the failures after gastrectomy. Ann R Coll Surg Engl 1948; 3(5):266-84.
(18) Praderi LA, Balboa O, Ricciardi N. Megaesófago, acalasia: nuestra experiencia. Cir Urug 1982; 52(4):323-33.
(19) Perrier JP, Fernández M, Sosa MC. Tratamiento quirúrgico de la acalasia y la opción de la cirugía laparoscópica. Cir Urug 2000; 70(1):36-44.
(20) Rodríguez G, Fernández G, Gatti A, Balboa O. Cirugía del hiato esofágico: abordaje video laparoscópico. Cir Urug 2003; 73(1):68-91.
(21) Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc 2007; 21(5):713-8.
(22) Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003; 138(5):490-5; discussion 495-7.
(23) Ellis FH Jr, Crozier RE, Gibb SP. Reoperative achalasia surgery. J Thorac Cardiovasc Surg 1986; 92(5):859-65. Erratum in: J Thorac Cardiovasc Surg 1987; 93(4):559.
(24) Malthaner RA, Tood TR, Miller L, Pearson FG. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg 1994; 58(5):1343-6; discussion 1346-7.
(25) Dor J, Humbert P, Dor V, Figarella J. L'interet de la technique de Nissen modifiee dans la prevention de reflux apres cardiomyotomie extramuqueuse de Heller. Mem Acad Chir (Paris) 1962; 88:877-83.
(26) Bonavina L, Nosadini A, Bardini R, Baessato M, Peracchia A. Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. Arch Surg 1992; 127(2):222-6.
(27) Zhu ZJ, Chen LQ, Duranceau A. Long-term result of total versus partial fundoplication after esophagomyotomy for primary esophageal motor disorders. World J Surg 2008; 32(3):401-7.
(28) Donahue PE, Schlesinger PK, Sluss KF, Richter HM, Liu KJ, Rypins EB, et al. Esophagocardiomyotomy-floppy Nissen fundoplication effectively treats achalasia without causing esophageal obstruction. Surgery 1994; 116(4):719-24.
(29) Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor undoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 2008; 248(6):1023-30.
(30) Orringer MB, Stirling MC. Esophageal resection for achalasia: indications and results. Ann Thorac Surg 1989; 47(3):340-5.
(31) Pinotti HW, Cecconello I, da Rocha JM, Zilberstein B. Resection for achalasia of the esophagus. Hepatogastroenterology 1991; 38(6):470-3.
(32) Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 1999; 230(4):587-93.
(33) Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 2008; 12(1):159-65.
Downloads
Published
2013-03-31
How to Cite
1.
Rodríguez Temesio G, González González D, Ruso L. Laparoscopic treatment of achalasia in a low prevalence healthcare setting. Rev. Méd. Urug. [Internet]. 2013 Mar. 31 [cited 2024 Sep. 7];29(1):26-32. Available from: https://revista.rmu.org.uy/index.php/rmu/article/view/296
Issue
Section
Original Articles
