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Related Experiment Videos

Surgery for achalasia: 1998.

Y Shiino1, C J Filipi, Z T Awad

  • 1Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska 63131, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|September 11, 1999
PubMed
Summary
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Surgical treatment for achalasia remains debated. While minimally invasive myotomy shows promise, adding fundoplication to transabdominal myotomy improves outcomes, unlike transthoracic approaches.

Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Surgical treatment for achalasia involves controversies regarding optimal techniques.
  • Key debates include the necessity of antireflux procedures and surgical approaches.

Purpose of the Study:

  • To review the literature and determine the value of concomitant antireflux procedures in achalasia surgery.
  • To compare different surgical approaches, myotomy lengths, and minimally invasive techniques.

Main Methods:

  • Literature review of 23 open transabdominal/transthoracic myotomy articles, 14 laparoscopic myotomy articles, and 4 thoracoscopic myotomy articles.
  • Analysis of postoperative symptomatology and pH monitoring data.

Main Results:

Related Experiment Videos

  • Open thoracic or transabdominal myotomy with fundoplication showed better symptomatic results than without.
  • High incidence of postoperative reflux was noted in transabdominal myotomy without fundoplication.
  • Transthoracic Heller myotomy did not necessitate a concomitant fundoplication.
  • Laparoscopic and thoracoscopic myotomy demonstrated excellent short-term results.

Conclusions:

  • Fundoplication is recommended for transabdominal myotomy but not for transthoracic Heller myotomy.
  • Minimally invasive achalasia surgery shows promising initial outcomes, but longer follow-up is needed.
  • Further randomized trials are required to establish the optimal fundoplication and myotomy length.