| Laparoscopic Heller myotomy relieves dysphagia in patients with achalasia and low LES pressure following pneumatic dilatation. | |
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MedLine Citation:
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PMID: 11591969 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Although pneumatic dilatation is said to relieve dysphagia in achalasia if it decreases lower esophageal sphincter (LES) pressure to 10 mmHg (n = 23); group C, no previous balloon dilatation and LES pressure >10 mmHg (n = 25). All patients underwent a laparoscopic Heller myotomy and Dor fundoplication. The severity of dysphagia was gauged on a scale of 0-4. RESULTS: In group A, LES pressure was 7 +/- 2 mmHg preoperatively and 8 +/- 3 mmHg postoperatively; the dysphagia score was 3.3 +/- 0.7 preoperatively and 0.9 +/- 1.1 postoperatively. Eighty-nine percent of patients had excellent or good results. In group B, LES pressure was 23 +/- 8 mmHg preoperatively and 10 +/- 1 mmHg postoperatively; the dysphagia score was 3.3 +/- 0.7 preoperatively and 0.3 +/- 0.5 postoperatively. All patients had excellent or good results. In group C, LES pressure was 23 +/- 11 mmHg preoperatively and 14 +/- 12 mmHg postoperatively; the dysphagia score was 3.6 +/- 0.6 preoperatively and 0.2 +/- 0.5 postoperatively. All patients had excellent or good results. CONCLUSIONS: These results show that (a) a LES pressure of <10 mmHg after pneumatic dilatation does not guarantee relief of dysphagia, and (b) laparoscopic Heller myotomy relieves dysphagia in most patients with a postdilatation LES pressure <10 mmHg. Thus, a laparoscopic Heller myotomy is indicated if dilatation does not relieve dysphagia, even if LES pressure has been decreased to <10 mmHg. Esophagectomy should be reserved for the occasional failure of this simpler operation. |
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Authors:
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U Diener; M G Patti; D Molena; A Tamburini; P M Fisichella; K Whang; L W Way |
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Publication Detail:
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Type: Journal Article Date: 2001-05-11 |
Journal Detail:
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Title: Surgical endoscopy Volume: 15 ISSN: 1432-2218 ISO Abbreviation: Surg Endosc Publication Date: 2001 Jul |
Date Detail:
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Created Date: 2001-10-09 Completed Date: 2002-02-04 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8806653 Medline TA: Surg Endosc Country: Germany |
Other Details:
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Languages: eng Pagination: 687-90 Citation Subset: IM |
Affiliation:
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Department of Surgery, University of California, 533 Parnassus Avenue, San Francisco, CA 94143-0788, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Balloon Dilatation / methods* Barium Sulfate / diagnostic use Deglutition Disorders / physiopathology, prevention & control, therapy* Esophageal Achalasia / physiopathology, surgery, therapy* Esophagogastric Junction / physiopathology* Esophagus / radiography, surgery* Female Follow-Up Studies Fundoplication / methods Humans Laparoscopy / methods* Male Manometry Middle Aged Muscle, Smooth / physiopathology, surgery Severity of Illness Index Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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7727-43-7/Barium Sulfate |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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