Document Detail


Laparoscopic cardiomyotomy for achalasia: long-term outcomes.
MedLine Citation:
PMID:  16813618     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although the laparoscopic approach to oesophageal myotomy for achalasia is associated with reduced early postoperative morbidity compared with the open approach, most published reports describe relatively short-term follow up. For this reason, in a prospective cohort study, we determined the longer-term outcome for patients with uncomplicated achalasia who underwent a laparoscopic myotomy. In addition, we sought to identify preoperative factors predicting a good postoperative outcome. METHODS: The outcome for 167 patients who underwent a laparoscopic cardiomyotomy and anterior partial fundoplication at one of two teaching hospitals was determined. All patients underwent preoperative assessment with a contrast swallow radiology, gastroscopy and oesophageal manometry. Patients also underwent objective symptom evaluation before and after surgery using various outcome scales to determine dysphagia, reflux symptoms, side-effects and overall satisfaction with the clinical outcomes. Patients were followed prospectively at yearly time points and data were managed on a computerized database. Postoperative objective investigations were undertaken if clinically indicated. RESULTS: Median operating time was 78 min (range, 30-210 min). Most patients left the hospital within 72 h of surgery. Surgery was associated with a 5% complication rate and a 4% rate of conversion to open surgery. Five per cent of patients required a subsequent intervention during follow up. Over longer-term follow up (5 years or longer), 77% of patients had either no or minimal symptoms. At 1, 3 and 5 years, 96, 93 and 97% of patients indicated that they thought that they had made the correct decision to undergo surgery, although men consistently fared worse on their reported dysphagia outcome across a range of measures. CONCLUSION: Laparoscopic myotomy with anterior partial fundoplication achieves a good outcome for patients undergoing treatment of achalasia. Male patients do not perceive their outcome to be optimal in comparison with females but in the long term, they do not regret proceeding.
Authors:
Justin R Bessell; Carolyn J Lally; Anne Schloithe; Glyn G Jamieson; Peter G Devitt; David I Watson
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  ANZ journal of surgery     Volume:  76     ISSN:  1445-1433     ISO Abbreviation:  ANZ J Surg     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-03     Completed Date:  2006-09-14     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  101086634     Medline TA:  ANZ J Surg     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  558-62     Citation Subset:  IM    
Affiliation:
Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, SA, Australia. jbessell@gisurgery.net
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Cardia / surgery*
Esophageal Achalasia / surgery*
Female
Follow-Up Studies
Humans
Laparoscopy / methods*
Male
Middle Aged
Muscle, Smooth / surgery
Prospective Studies
Time Factors
Treatment Outcome

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


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