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Surgical Treatment of Esophageal Achalasia

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Surgical Management of Benign Esophageal Disorders

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Abstract

The last two decades have witnessed an extraordinary evolution in the treatment of esophageal achalasia. Nowadays, laparoscopic Heller myotomy with partial fundoplication is considered in most centers the standard of care, while pneumatic dilatation is mainly reserved for the management of patients unfit for surgery or in case of surgical failure. Recently, the peroral endoscopic myotomy (POEM) has been proposed as a new approach to achalasia.

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References

  1. Fisichella PM, Raz D, Palazzo F, Niponmick I, Patti MG. Clinical, radiological, and manometric profile in 145 patients with untreated achalasia. World J Surg. 2008;32:1974–9.

    Article  PubMed  Google Scholar 

  2. Allescher HD, Storr M, Seige M, Gonzales-Donoso R, Ott R, Born P, et al. Treatment of achalasia: botulinum toxin injection vs. pneumatic balloon dilation. A prospective study with long-term follow-up. Endoscopy. 2001;33:1007–17.

    Article  PubMed  CAS  Google Scholar 

  3. Vaezi MF, Richter JE, Wilcox CM, Schroeder PL, Birgisson S, Slaughter RL, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut. 1999;44:231–9.

    Article  PubMed  CAS  Google Scholar 

  4. Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg. 2004;239:364–70.

    Article  PubMed  Google Scholar 

  5. Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999;11:2270–6.

    Article  Google Scholar 

  6. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg. 2006;243:579–86.

    Article  PubMed  Google Scholar 

  7. Stefanidis D, Richardson W, Farrell TM, Kohn GP, Augenstein V, Fanelli RD, Society of American Gastrointestinal and Endoscopic Surgeons. SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc. 2012;26:296–311.

    Article  PubMed  Google Scholar 

  8. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttitta A, Elizalde JI, Fumagalli U, Gaudric M, Rohof WO, Smout AJ, Tack J, Zwinderman AH, Zaninotto G, Busch OR, European Achalasia Trial Investigators. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364:1807–16.

    Article  PubMed  CAS  Google Scholar 

  9. West RL, Hirsch DP, Bartelsman JFWM, de Borst J, Ferwerda G, Tytgat GNJ, et al. Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002;97:1346–51.

    Article  PubMed  CAS  Google Scholar 

  10. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.

    Article  PubMed  CAS  Google Scholar 

  11. Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012;256:659–67.

    Article  PubMed  Google Scholar 

  12. Hungness ES, Teitelbaum EN, Santos BF, Arafat FO, Pandolfino JE, Kahrilas PJ, et al. Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J Gastrointest Surg. 2013;17:228–35.

    Article  PubMed  Google Scholar 

  13. Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia. Ann Surg. 2008;248:1023–30.

    Article  PubMed  Google Scholar 

  14. Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007;21:713–8.

    Article  PubMed  CAS  Google Scholar 

  15. Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G, Nicoletti L, Cavallin F, Battaglia G, Ruol A, Ancona E. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248:986–93.

    Article  PubMed  Google Scholar 

  16. Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S, Way LW. Laparoscopic Heller myotomy and Dor fundoplication for achalasia. Analysis of successes and failures. Arch Surg. 2001;136:870–7.

    Article  PubMed  CAS  Google Scholar 

  17. Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg. 2008;12:159–65.

    Article  PubMed  Google Scholar 

  18. Mineo TC, Pompeo E. Long-term outcome of Heller myotomy in achalasic sigmoid esophagus. J Thorac Cardiovasc Surg. 2004;128:402–7.

    Article  PubMed  Google Scholar 

  19. Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg. 2003;138:490–7.

    Article  PubMed  Google Scholar 

  20. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication. A prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–15.

    Article  PubMed  Google Scholar 

  21. Portale G, Costantini M, Rizzetto C, Guirroli E, Ceolin M, Salvador R, Ancona E, Zaninotto G. Long-term outcome of laparoscopic Heller-Dor surgery for esophageal achalasia. Possible detrimental role of previous endoscopic treatment. J Gastrointest Surg. 2005;9:1332–9.

    Article  PubMed  Google Scholar 

  22. Burpee SE, Mamazza J, Schlachta CM, Bendavid Y, Klein L, Moloo H, Poulin EC. Objective analysis of gastroesophageal reflux after laparoscopic Heller myotomy: an anti-reflux procedure is required. Surg Endosc. 2005;19:9–14.

    Article  PubMed  CAS  Google Scholar 

  23. Falkenback D, Johansson J, Oberg S, Kjellin A, Wenner J, Zilling T, Johnsson F, Von Holstein CS, Walther B. Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus. 2003;16:284–90.

    Article  PubMed  CAS  Google Scholar 

  24. Rawlings A, Soper NJ, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26:18–26.

    Article  PubMed  Google Scholar 

  25. Patti M, Herbella FA. Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: what type? J Gastrointest Surg. 2010;14:1453–8.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Ave, MC 5095, Room G-207, Chicago, IL, 60637, USA

    Marco E. Allaix MD & Marco G. Patti MD

  2. Department of Surgery, Stritch School of Medicine, Loyola University Medical Center, 2160 South 1st Avenue, Maywood, IL, 60153, USA

    Adrian Dobrowolsky MD

Authors
  1. Marco E. Allaix MD
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  2. Adrian Dobrowolsky MD
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  3. Marco G. Patti MD
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Corresponding author

Correspondence to Marco G. Patti MD .

Editor information

Editors and Affiliations

  1. Loyola University Medical Center, Maywood, Illinois, USA

    P. Marco Fisichella

  2. Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA

    Nathaniel J. Soper

  3. Department of Surgery, University of Washington Medical Center, Seattle, USA

    Carlos A. Pellegrini

  4. Chicago, Illinois, USA

    Marco G. Patti

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© 2014 Springer-Verlag London

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Allaix, M.E., Dobrowolsky, A., Patti, M.G. (2014). Surgical Treatment of Esophageal Achalasia. In: Fisichella, P., Soper, N., Pellegrini, C., Patti, M. (eds) Surgical Management of Benign Esophageal Disorders. Springer, London. https://doi.org/10.1007/978-1-4471-5484-6_12

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  • DOI: https://doi.org/10.1007/978-1-4471-5484-6_12

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-5483-9

  • Online ISBN: 978-1-4471-5484-6

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