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Short myotomy for vigorous achalasia
P Parrilla Paricio1, L F Martinez de Haro, A Ortiz Escandell
1Department of Surgery, University Hospital Virgen de la Arrixaca, El Palmar, Murcia, Spain.
The British Journal of Surgery
|December 1, 1993
Summary
Vigorous achalasia surgery using an abdominal approach with limited myotomy of the lower esophageal sphincter (LES) yielded excellent results. This study suggests vigorous achalasia may not require extended myotomy, challenging the term's therapeutic significance.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Esophageal Motility Disorders
Background:
- Vigorous achalasia traditionally necessitates thoracic surgery with extended myotomy.
- The necessity of extensive myotomy for vigorous achalasia remains debated.
Purpose of the Study:
- To evaluate the efficacy of abdominal surgery with limited lower esophageal sphincter (LES) myotomy in treating vigorous achalasia.
- To determine if extended myotomy is essential for successful surgical outcomes in vigorous achalasia.
Main Methods:
- Retrospective analysis of 16 patients with vigorous achalasia who underwent abdominal surgery.
- Myotomy was limited to the lower esophageal sphincter (LES).
- Clinical outcomes and postoperative manometric findings were assessed.
Main Results:
- All patients achieved excellent or good clinical results.
- Significant reduction in esophageal diameter observed post-surgery (P < 0.01).
- Postoperative manometry showed decreased LES resting pressure, reduced wave amplitude, and fewer repetitive waves.
Conclusions:
- Abdominal surgery with limited LES myotomy is effective for vigorous achalasia.
- Extended myotomy may not be necessary, questioning the therapeutic distinction of 'vigorous' achalasia.