Laparoscopic Heller myotomy is equally efficient and safe in patients who had pre-myotomy endoscopic interventions when compared with those with no interventions

Yıl 2017, Cilt: 2 Sayı: 1, 1 - 4, 16.04.2017

Zeynep Bilgi Adamu Issaka Hasan Fevzi Batırel

Öz

Background:
Endoscopic treatment (ET) methods for achalasia such
as balloon dilatation and botulinum toxin injection has good success for short
and medium term management of achalasia. However some patients either need
repeat attempts or referred to surgery. In this study we analyzed and compared the
perioperative and disease specific quality of life outcomes of achalasia
patients who either underwent surgery as a first line treatment and the ones
who underwent ET method prior to surgery.

Materials and Methods: The patients who underwent standard of
care diagnostic workup and surgery for achalasia by the same surgical team
between 2007 and 2014 were recorded in a prospective database. The patients who
underwent surgery as a first line treatment (Group 1, n=55) and the patients
who underwent prior ET (Group 2, n=33) were identified. Demographic data,
peroperative complications, length of hospital stay, pre- and postoperative
Eckardt scores were recorded and analyzed.

Results:
A total of 88 patients out of 105 were available for
follow up with average follow up time of 61.9 ± 35.8 months. The mean age was
43.3 ± 15.6. Mean hospital stay was 2.3 ± 0.8 days and there was no mortality.
Average duration of the effectivity of ET before myotomy was 5.7 ± 7.7 months.
Peroperative complications not significantly accumulated in either group. Both
groups showed comparable drop in Eckardt scores.

Conclusions: Heller
myotomy and Dor fundoplication is a safe and durable option for treatment of
achalasia for both treatment naive patients and patients with previous repeated
ET modalities. 

Anahtar Kelimeler

Achalasia, Heller myotomy, botulinum toxin, surgery

Kaynakça

• 1. Alexander J. Eckardt, Volker F. Eckardt Treatment and surveillance strategies in achalasia: an update. Nat Rev Gastroenterol Hepatol 2011; 8: 311-319.
• 2. Gupta M, Ghoshal UC, Jindal S, Misra A, Nath A, Saraswat VA. Respiratory dysfunction is common in patients with achalasia and improves after pneumatic dilation. Dig Dis Sci 2014; 59: 744-52.
• 3. Roman S, Kahrilas PJ, Mion F, Nealis TB, Soper NJ, Poncet G, et al. Partial recovery of peristalsis after myotomy for achalasia: more the rule than the exception. JAMA Surg 2013; 148: 157-64.
• 4. Richter JE, Boeckxstaens GE. Management of achalasia: surgery or pneumatic dilation. Gut 2011; 60: 869-76.
• 5. Krishnamohan P, Allen MS, Shen KR, Wigle DA, Nichols FC 3rd, Cassivi SD, et al. Long-term outcome after laparoscopic myotomy for achalasia. J Thorac Cardiovasc Surg 2014; 147: 730-6.
• 6. Sharata AM, Dunst CM, Pescarus R, Shlomovitz E, Wille AJ, Reavis KM, et al. Peroral endoscopic myotomy (POEM) for esophageal primary motility disorders: analysis of 100 consecutive patients. J Gastrointest Surg 2015; 19: 161-70; discussion 170.
• 7. Bloomston M, Fraiji E, Boyce HW Jr, Gonzalvo A, Johnson M, Rosemurgy AS. Preoperative intervention does not affect esophageal muscle histology or patient outcomes in patients undergoing laparoscopic Heller myotomy. J Gastrointest Surg 2003; 7: 181-8; discussion 188-90.
• 8. Schoenberg MB, Marx S, Kersten JF, Rösch T, Belle S, Kähler G, et al. Laparoscopic Heller myotomy versus endoscopic balloon dilatation for the treatment of achalasia: a network meta-analysis. Ann Surg 2013; 258: 943-52.
• 9. Yaghoobi M, Mayrand S, Martel M, Roshan-Afshar I, Bijarchi R, Barkun A. Laparoscopic Heller's myotomy versus pneumatic dilation in the treatment of idiopathic achalasia: a meta-analysis of randomized, controlled trials. Gastrointest Endosc 2013; 78: 468-75.
• 10. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, et al. Pneumatic dilation versus laparoscopic Heller's myotomy for idiopathic achalasia. N Engl J Med 2011; 364: 1807-16.
• 11. Kilic A, Schuchert MJ, Pennathur A, Gilbert S, Landreneau RJ, Luketich JD. Long-term outcomes of laparoscopic Heller myotomy for achalasia. Surgery 2009; 146: 826-31; discussion 831-3.
• 12. Chan KC, Wong SK, Lee DW, Mui WL, Chan AC, Ng EK, et al. Short-term and long-term results of endoscopic balloon dilation for achalasia: 12 years' experience. Endoscopy 2004; 36: 690-4.