Document Detail


Patterns of esophageal acid exposure after laparoscopic Heller's myotomy and Dor's fundoplication for esophageal achalasia.
MedLine Citation:
PMID:  18095027     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Heller's myotomy for esophageal achalasia is associated with less esophageal acid gastroesophageal reflux when combined a Dor's fundoplication. The Aim of the study was to assess the incidence of postoperative esophageal acid exposure after laparoscopic Heller's myotomy and Dor's fundoplication (HM-DF). METHODS: Seventy six patients (37 males) with esophageal achalasia were prospectively followed-up by clinical interview and laboratory tests before and after laparoscopic HM-DF. A symptom score was used for clinical assessment. Laboratory assessment included esophageal standard manometry, esophagogram and esophageal pH 24-hour monitoring before and 1- and 5-years after surgery. RESULTS: Symptom score improved at 1-year after surgery (P < 0.001). Heartburn was only reported by 5 patients, dysphagia or/and regurgitation by 28 and substernal pain by 12. 91% of patients had satisfactory functional results. Pathological esophageal exposure to acid was seen in 21% of the cases. Pathological acid events showed the features of pseudoreflux in 66%t and those of true GER in 34%. Pathologically increased esophageal exposure to acid was more commonly detected in patients with a pseudodiverticulum (P = 0.001) and was related to the diameter of distal esophagus and symptom score (P < 0.001). There was no reduction in esophageal acid exposure after treatment with proton pump inhibitors in 16 patients. Neither the symptom score nor esophageal acid exposure at esophageal pH monitoring changed significantly at the 5-year follow-up in 35 patients. Esophageal configuration remained unchanged. CONCLUSIONS: Increased esophageal exposure to acid after laparoscopic HM-DF for esophageal achalasia i) is detected in 21% of patients, and is rather the result of food stagnation than of true GER, ii) is more commonly seen in cases with pseudodiverticulum, iii) is related to the diameter of distal esophagus, iv) does not respond to antisecretory treatment and v) does not deteriorate by time.
Authors:
John Tsiaoussis; George Pechlivanides; Nikolaos Gouvas; Elias Athanasakis; Nikolaos Zervakis; Apostolos Manitides; Evaghelos Xynos
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2007-12-20
Journal Detail:
Title:  Surgical endoscopy     Volume:  22     ISSN:  1432-2218     ISO Abbreviation:  Surg Endosc     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-13     Completed Date:  2008-07-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8806653     Medline TA:  Surg Endosc     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1493-9     Citation Subset:  IM    
Affiliation:
Department of Surgery, Metropolitan Hospital of Athens, Athens, Greece. jtsiaoussis@metropolitan-hospital.gr
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Child
Esophageal Achalasia / metabolism,  surgery*
Esophageal pH Monitoring
Esophagus / metabolism*,  physiopathology,  surgery
Female
Follow-Up Studies
Fundoplication / adverse effects,  methods*
Gastric Acid / metabolism*
Gastroesophageal Reflux / diagnosis,  epidemiology*,  metabolism
Humans
Incidence
Laparoscopy / adverse effects,  methods*
Male
Manometry
Middle Aged
Postoperative Complications
Pressure
Prospective Studies
Risk Factors
Severity of Illness Index
Time Factors

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


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