Abstract
Background
It has been suggested that abnormal function of the lower esophageal sphincter is the primary abnormality in esophageal achalasia, and that the absence of esophageal peristalsis is secondary to the outflow obstruction caused by the lower esophageal sphincter. Furthermore, it has been proposed that early elimination of the resistance at the level of the gastroesophageal junction by surgical intervention could result in return of esophageal peristalsis. This study aimed to assess whether the timing of surgical intervention affects the return of esophageal peristalsis and the clinical outcome for patients with achalasia.
Methods
Between January 1991 and May 2003, 173 patients underwent a Heller myotomy by minimally invasive surgery for treatment of esophageal achalasia. Of these patients, 41 (24%) had pre- and postoperative esophageal manometry. These patients were divided into three groups based on the duration of symptoms: group A (10 patients; duration of symptoms 12 months group B (19 patients, duration of symptoms 12 to 60 months), and group C (12 patients; duration of symptoms longer than 60 months).
Results
The average duration of symptoms (dysphagia was present in all patients) was as follows: group A (8 ± 4 months), group B, (35 ± 16 months), and group C, (157 ± 94 months). Vigorous achalasia was present in 40%, 21%, and 17% of the groups respectively. The differences between the groups were not significant. Postoperatively, improvement in esophageal motility was seen in no patient in group A, 1 patient (5%) in group B, and 1 patient (8%) in group C. Excellent or good results were obtained for 90% of the group A patients, 95% of group B patients, and 92% of the group C patients. Again, the differences were not significant.
Conclusions
The results show that: a) the presence of vigorous achalasia is independent of symptoms duration; b) the timing of surgical intervention does not influence the return of peristalsis; and c) the results of a Heller myotomy are independent of symptoms duration.
Similar content being viewed by others
References
Camacho-Lobato L, Katz PO, Eveland J, Vela M, Castell DO (2001) Vigorous achalasia: original description requires minor change. J Clin Gastroenterol 33: 375–377
Eckardt VF, Stauf B, Bernhard G (1999) Chest pain in achalasia: patient characteristics and clinical course. Gastroenterology 116: 1300–1304
Goldblum JR, Whyte RI, Orringer MB, Appelman HD (1994). Achalasia: a morphologic study of 42 resected specimens. Am J Surg PathoL 18: 327–337
Goldenberg SP, Burrell M, Fette GG, Vos C, Traube M (1991) Classic and vigorous achalasia: a comparison of manometric, radiographic, and clinical findings. Gastroenterology 101: 743–748
Gorodner MV, Galvani C, Fisichella PM, Patti MG (2004) Preoperative lower esophageal sphincter pressure has little influence on the outcome of laparoscopic Heller myotomy for achalasia. Surg Endosc., DOI: 10.1007/s00464-003-8826-1, 2 April 2004
Little AG, Correnti FS, Calleja IJ, Montag AG, Chow YC, Ferguson MK, Skinner DB (1986) Effect of incomplete obstruction on feline esophageal function with a clinical correlation. Surgery 100: 430–436
Papo M, Mearin F, Castro A, Armengol JR, Malagelada JR (1997) Chest pain and reappearance of esophageal peristalsis in treated achalasia. Scand J Gastroenterol 32: 1190–1194
Parrilla P, de Martinez Haro LF, Ortiz A, Morales G, Garay V, Aguilar J (1995) Factors involved in the return of peristalsis in patients with achalasia of the cardia after Heller’s myotomy. Am J Gastroenterol 90: 713–717
Patti MG, Arcerito M, De Pinto M, Feo CV, Tong J, Gantert W, Way LW (1998) Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. Gastrointest Surg 2: 561–566
Patti MG, Arcerito M, Tong J, De Pinto M, de Bellis M, Wang A, Feo CV, Mulvihill SJ, Way LW (1997). Importance of preoperative and postoperative pH monitoring in patients with esophageal achalasia. J Gastrointest Surg 1: 505–510
Pellegrini C, Wetter LA, Patti M, Leichter R, Mussan G, Mori T, Bernstein G, Way L (1992) Thoracoscopic esophagomyotomy: initial experience with a new approach for the treatment of achalasia. Ann Surg 216:291–296
Perretta S, Fisichella PM, Galvani C, Gorodner MV, Way LW, Patti MG (2003) Achalasia and chest pain: effect of laparoscopic Heller myotomy. J Gastrointest Surg 7: 595–598
Reynolds JC, Parkman HP (1989) Achalasia. Gastroenterol Clin North Am 18: 223–255
Ribeiro AC, Klingler PJ, Hinder RA, De Vault K (1998) Esophageal manometry: a comparison of findings in younger and older patients. Am J Gastroenterol 93: 706–710
Schneider JH, Peters JH, Kirkman E, Bremner CG, DeMeester TR (1999) Are the motility abnormalities of achalasia reversible? An experimental outflow obstruction in the feline model. Surgery 125: 498–503
Vaezi MF, Richter JE (1999) Diagnosis and management of achalasia. Am J Gastroenterol 94: 3406–3412
Vantrappen G, Janssens J, Hellemans J, Coremans G (1979) Achalasia, diffuse esophageal spasm, and related motility disorders. Gastroenterology 76: 450–457
Zaninotto G, Costantini M, Anselmino M, Boccu C, Ancona E (1995). Onset of oesophageal peristalsis after surgery for idiopathic achalasia. Br J Surg 82: 1532–1534
Author information
Authors and Affiliations
Corresponding author
Additional information
Presented at the Poster Session of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) Denver, Colorado, 2004
Rights and permissions
About this article
Cite this article
Patti, M.G., Galvani, C., Gorodner, M.V. et al. Timing of surgical intervention does not influence return of esophageal peristalsis or outcome for patients with achalasia. Surg Endosc 19, 1188–1192 (2005). https://doi.org/10.1007/s00464-004-8199-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-004-8199-0