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Journal of Gastrointestinal Surgery

, Volume 13, Issue 6, pp 1029–1036 | Cite as

Minimally Invasive Surgical Treatment of Sigmoidal Esophagus in Achalasia

  • Matthew J. SchuchertEmail author
  • James D. Luketich
  • Rodney J. Landreneau
  • Arman Kilic
  • Yun Wang
  • Miguel Alvelo-Rivera
  • Neil A. Christie
  • Sebastien Gilbert
  • Arjun Pennathur
SSAT Plenary Presentation

Abstract

Background

The appropriate surgical intervention for sigmoidal esophagus in the setting of achalasia remains controversial. The objective of this study is to review our experience with minimally invasive myotomy (MIM) and minimally invasive esophagectomy (MIE) in the treatment of these patients.

Methods

We reviewed the records of 30 patients (19 men, 11 women); mean age 59.1 years (range 25–83 years) who underwent MIM (n = 24) or MIE (n = 6). Primary variables included perioperative and long-term outcomes. Univariate and multivariate analyses were performed to identify clinical variables predictive of myotomy failure.

Results

The operative mortality was zero and median hospital stay was 2 days (MIM) and 7 days (MIE). On follow-up (mean 30.5 months), nine (37.5%) patients undergoing primary MIM had failure requiring redo myotomy (n = 1) or esophagectomy (n = 8). Univariate analysis showed that previous myotomy and duration of symptoms were significant predictors of failure of MIM, with patient age trending toward significance. Multivariate analysis showed age and longer symptom duration to be significant.

Conclusions

MIM affords symptomatic improvement in many patients. Age and symptom duration may be preoperative indicators of MIM failure. MIE offers similar symptom relief but is associated with a longer hospital stay. Further prospective studies are required to define the optimum treatment algorithm in the management of these patients.

Keywords

Achalasia Sigmoid esophagus Minimally invasive Myotomy Esophagectomy 

Notes

Acknowledgements

The authors wish to acknowledge the important contributions of Diane Sabilla, Kathy Lovas, Theresa Krupka, and Darla Justus in database organization and management.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • Matthew J. Schuchert
    • 1
  • James D. Luketich
    • 1
  • Rodney J. Landreneau
    • 1
  • Arman Kilic
    • 1
  • Yun Wang
    • 2
  • Miguel Alvelo-Rivera
    • 1
  • Neil A. Christie
    • 1
  • Sebastien Gilbert
    • 1
  • Arjun Pennathur
    • 1
  1. 1.Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery InstituteUPMC Health SystemPittsburghUSA
  2. 2.Department of BiostatisticsUniversity of Pittsburgh Cancer InstitutePittsburghUSA

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