Document Detail


Laparoscopic Heller myotomy relieves dysphagia in patients with achalasia and low LES pressure following pneumatic dilatation.
MedLine Citation:
PMID:  11591969     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
U Diener; M G Patti; D Molena; A Tamburini; P M Fisichella; K Whang; L W Way
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Publication Detail:
Type:  Journal Article     Date:  2001-05-11
Journal Detail:
Title:  Surgical endoscopy     Volume:  15     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2001 Jul 
Date Detail:
Created Date:  2001-10-09     Completed Date:  2002-02-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  687-90     Citation Subset:  IM    
Affiliation:
Department of Surgery, University of California, 533 Parnassus Avenue, San Francisco, CA 94143-0788, USA.
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MeSH Terms
Descriptor/Qualifier:
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:
7727-43-7/Barium Sulfate

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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