Minimally Invasive Surgical Treatment of Sigmoidal Esophagus in Achalasia

Overview

Journal J Gastrointest Surg

Specialty Gastroenterology

Date 2009 Mar 28

PMID 19326178

Citations 7

Authors

Matthew J Schuchert

James D Luketich

Rodney J Landreneau

Arman Kilic

Yun Wang

Miguel Alvelo-Rivera

Neil A Christie

Sebastien Gilbert

Arjun Pennathur

Affiliations

Soon will be listed here.

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.

Citing Articles

Surgical Options for End-Stage Achalasia.

DeSouza M Curr Gastroenterol Rep. 2023; 25(11):267-274.

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Peroral endoscopic myotomy: techniques and outcomes.

Petrov R, Fajardo R, Bakhos C, Abbas A Shanghai Chest. 2021; 5.

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Endoscopic and Surgical Treatments for Achalasia: Who to Treat and How?.

Fajardo R, Petrov R, Bakhos C, Abbas A Gastroenterol Clin North Am. 2020; 49(3):481-498.

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Esophagectomy for benign disease.

Mormando J, Barbetta A, Molena D J Thorac Dis. 2018; 10(3):2026-2033.

PMID: 29707359 PMC: 5906260. DOI: 10.21037/jtd.2018.01.165.

Esophagectomy for End-Stage Achalasia: Systematic Review and Meta-analysis.

Aiolfi A, Asti E, Bonitta G, Bonavina L World J Surg. 2017; 42(5):1469-1476.

PMID: 29022068 DOI: 10.1007/s00268-017-4298-7.

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