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Oesophagocardiomyotomy and antireflux procedures
Insights
Oesophagocardiomyotomy for achalasia cardiae can lead to gastro-oesophageal reflux. Combining Heller's operation with an antireflux procedure in selected patients significantly reduces reflux complications.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Digestive System Surgery
Background:
- Oesophagocardiomyotomy is a standard surgical treatment for achalasia cardiae.
- Variations in surgical technique contribute to inconsistent outcomes, particularly concerning postoperative gastro-oesophageal reflux.
Purpose of the Study:
- To evaluate the efficacy of combining oesophagocardiomyotomy with an antireflux procedure in managing achalasia cardiae.
- To determine the impact of preoperative reflux assessment on surgical outcomes.
Main Methods:
- A retrospective analysis of 63 patients undergoing primary oesophagocardiomyotomy.
- Comparison of outcomes between patients receiving oesophagocardiomyotomy alone versus those with combined antireflux procedures.
- Preoperative screening for reflux-predisposing conditions was performed in a subset of patients.
Main Results:
- Eight out of 41 patients (without preoperative reflux assessment) developed severe reflux complications after oesophagocardiomyotomy alone.
- All 22 patients who underwent Heller's operation combined with an antireflux procedure showed good outcomes with no detected pathological gastro-oesophageal reflux during follow-up (mean 4 years).
Conclusions:
- Oesophagocardiomyotomy should be augmented with an antireflux procedure in carefully selected achalasia cardiae patients.
- Preoperative evaluation for reflux risk is crucial for optimizing surgical strategy and patient outcomes.
Abstract:
Although oesophagocardiomyotomy has been the method of choice for surgical treatment of achalasia cardiae for several decades, there are still great discrepancies in the technical details of the procedure as performed in different centres. This is one of the main explanations for the diverging results reported, particularly with regard to the incidence of postoperative gastro-oesophageal reflux. Sixty-three patients underwent primary oesophagocardiomyotomy with a total length of 12 cm, including incision of about 2 cm onto the stomach. Forty-one patients were not examined preoperatively for conditions now recognized as predisposing to reflux and were managed with oesophagocardiomyotomy only, except one patient. Eight patients developed severe reflux complications from 1 to 5 years (mean 2 years) after the operation. In 11 out of 22 patients examined preoperatively for such conditions, Heller's operation was combined with an antireflux procedure. The results were good in all patients and pathological gastro-oesophageal reflux was not detected in any of the 22 patients during a follow-up period of 2 to 7 years (mean 4 years). It is concluded that oesophagocardiomyotomy should be combined with an antireflux procedure in selected patients. The indications for an antireflux procedure are discussed.