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Laparoscopic stapled cardioplasty for failed treatment of achalasia
T C B Dehn1, M Slater, N J Trudgill
1Department of Upper Gastrointestinal Surgery, Royal Berkshire Hospital, Reading, UK. Thomas.Dehn@royalberkshire.nhs.uk
Insights
Laparoscopic stapled cardioplasty (LSC) offers a promising solution for patients with achalasia resistant to traditional treatments. This procedure demonstrated high success rates in improving swallowing and weight in a small patient cohort.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Motility Disorders
Background:
- Achalasia treatment options include botulinum toxin injection, pneumatic dilatation, and surgical myotomy, all with known failure rates.
- Failed treatments for achalasia often leave limited surgical options, historically leading to oesophagectomy.
- Laparoscopic stapled cardioplasty (LSC) presents a potential alternative for managing complex achalasia cases.
Purpose of the Study:
- To evaluate the efficacy and safety of Laparoscopic Stapled Cardioplasty (LSC) in patients with recurrent achalasia.
- To assess LSC as an alternative surgical option for achalasia refractory to multiple treatments.
Main Methods:
- Seven patients with recurrent achalasia, who had failed multiple prior treatments including myotomies, underwent LSC.
- Postoperative contrast swallows were performed before discharge to assess esophageal emptying.
- Clinical follow-up was conducted to evaluate long-term outcomes.
Main Results:
- All seven patients were discharged within 5 days post-LSC, with no anastomotic leaks observed.
- Postoperative swallows confirmed rapid esophageal emptying in all patients.
- After one year, six out of seven patients were symptom-free of dysphagia, and all gained weight. Four patients required proton pump inhibitors for heartburn management.
Conclusions:
- Laparoscopic stapled cardioplasty (LSC) appears to be a safe and effective procedure for managing achalasia resistant to conventional therapies.
- LSC offers a viable surgical option for patients with complex or recurrent achalasia, potentially avoiding more extensive resections.
Background:
Treatment of primary achalasia includes injection of botulinum toxin, pneumatic dilatation or surgical myotomy. All of these procedures have an associated failure rate. Laparoscopic stapled cardioplasty (LSC) may be an alternative to failed pneumatic dilatation and laparoscopic Heller's myotomy where oesophagectomy has previously been the only surgical option.
Methods:
Selected patients with recurrent achalasia following multiple failed medical treatments, including myotomies, were managed by LSC. Patients had postoperative contrast swallows before discharge with clinical follow-up.
Results:
All seven patients treated with LSC were discharged within 5 days. Rapid oesophageal emptying was noted on all post-LSC contrast swallows. No patient had an anastomotic leak. After 1 year, all but one patient was free from dysphagia, all had gained weight, and four patients had heartburn controlled by a proton pump inhibitor.
Conclusion:
LSC may be a useful procedure for resistant achalasia.
