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  • 1
    Language: English
    In: Journal of Gastrointestinal Surgery, Feb, 2010, Vol.14(1), p.46(12)
    Description: Byline: Ines Gockel (1), Stephan Timm (1), George G. Sgourakis (1), Thomas J. Musholt (1), Andreas D. Rink (1), Hauke Lang (1) Keywords: Myotomy; Achalasia; LES; Laparoscopic myotomy; Heller myotomy Abstract: Introduction Heller myotomy leads to good--excellent long-term results in 90% of patients with achalasia and thereby has evolved to the "first-line" therapy. Failure of surgical treatment, however, remains an urgent problem which has been discussed controversially recently. Materials and Methods A systematic review of the literature was performed to analyze the long-term results of failures after Heller's operation with emphasis on treatment by remedial myotomy. Discussion Other reinterventions and their causes after failure of surgical treatment in patients with achalasia are discussed. Author Affiliation: (1) Department of General and Abdominal Surgery, Johannes Gutenberg-University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany Article History: Registration Date: 25/08/2009 Received Date: 29/04/2009 Accepted Date: 25/08/2009 Online Date: 24/10/2009
    Keywords: Surgery -- Analysis
    ISSN: 1091-255X
    E-ISSN: 18734626
    Source: Cengage Learning, Inc.
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  • 2
    Language: English
    In: Journal of Gastrointestinal Surgery, 2006, Vol.10(10), pp.1400-1408
    Description: Myotomy has proved to be an efficient primary therapy in patients with achalasia, especially in younger patients (〈40 years of age). The results of laparoscopic myotomy cannot be finally assessed, on account of the shorter postoperative follow-up. Thus, there are considerable data regarding intermediate-term outcomes after laparoscopic myotomy. The aim of our study was a 20-year analysis of the conventional cardiomyotomy as the underlying basis assessing the results of minimal-invasive surgery. Within 20 years (September 1985 through September 2005), 161 operations for achalasia were performed in our clinic. Enrolled in this study were 108 patients with a conventional, transabdominal myotomy in combination with an anterior semifundoplication (Dor procedure) and a minimal follow-up of 6 months. All patients were prospectively followed and, in addition to radiologic and manometric examinations of the esophagus, the patients were asked for their clinical symptoms by structured interviews in 2-year intervals. The median age at the time of surgery was 44.5 (range, 14–78) years, and 72.2% of the patients were males. The median length of the preoperative symptoms was 3 years (3 months to 50 years), and the postoperative follow-up was 55 (range, 6-206) months. In 70 (64.8%) patients, a pneumatic dilation had been performed. The preoperative Eckardt score of 6 (range, 2–12) could be reduced to 1 (range, 0–4) after myotomy ( P 〈0.0001). Consequently, with 97.2% of all patients, a good-to-excellent result was achieved in the long-term follow-up, corresponding to a clinical stage I-II. Postoperatively, 69 patients (63.9%) gained weight. The radiologically measured maximum diameter of the esophagus decreased from preoperatively 45 (range, 20–75) mm to postoperatively 30 (range, 20–60) mm, while the minimum diameter of the cardia increased from 3.4 (range, 1–10) mm to 10 (range, 5–15) mm. The resting pressure of the lower esophageal sphincter could be reduced from 28.4 (range, 9.4–56.0) mm Hg to 8.6 (range, 3.0–22.5) mm Hg. Conventional myotomy leads in the long run with high efficiency to an improvement of the symptoms evident in achalasia. These results may be regarded as the basis for assessment of the minimal-invasive procedure.
    Keywords: Achalasia ; conventional myotomy ; prospective 20-year analysis ; basis for assessing the laparoscopic procedure
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 3
    Language: English
    In: Journal of Gastrointestinal Surgery, 2010, Vol.14(Supplement 1), pp.46-57
    Description: Issue Title: Festschrift: Tom R. DeMeester Heller myotomy leads to good-excellent long-term results in 90% of patients with achalasia and thereby has evolved to the "first-line" therapy. Failure of surgical treatment, however, remains an urgent problem which has been discussed controversially recently. A systematic review of the literature was performed to analyze the long-term results of failures after Heller's operation with emphasis on treatment by remedial myotomy. Other reinterventions and their causes after failure of surgical treatment in patients with achalasia are discussed.[PUBLICATION ]
    Keywords: Myotomy ; Achalasia ; LES ; Laparoscopic myotomy ; Heller myotomy
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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  • 4
    Language: English
    In: Journal of Gastrointestinal Surgery, 2003, Vol.7(5), pp.692-700
    Description: The aim of this study was to define the clinical presentation, motility characteristics, and prevalence and patterns of gastroesophageal reflux in patients with hypertensive lower esophageal sphincter (HTLES). HTLES was defined by a resting pressure measured at the respiratory inversion point on stationary manometry of greater than 26 mm Hg (ninety-fifth percentile of normal). One hundred consecutive patients (80 women, 20 men; mean age 54.7 years, range 23 to 89 years), diagnosed with HTLES at our institution between September 1996 and October 1999, were studied. Patients with achalasia or other named esophageal motility disorders or history of foregut surgery were excluded, but patients with both HTLES and “nutcracker esophagus” were included. The most common symptoms in patients with HTLES were regurgitation (75%), heartburn (71%), dysphagia (71%), and chest pain (49%). The most common primary presenting symptoms were heartburn and dysphagia. The intrabolus pressure, which is a manometric measure of outflow obstruction, was significantly higher in patients with HTLES compared to normal volunteers. The residual pressure measured during LES relaxation induced by a water swallow was also significantly higher than in normal persons. There were no significant associations between any of the relaxation parameters studied (residual pressure, nadir pressure, duration of relaxation, time to residual pressure) and either the presence or severity of any symptoms or the presence of abnormal esophageal acid exposure. Seventy-three patients underwent 24-hour pH monitoring, and 26% had increased distal esophageal acid exposure. Compared to a cohort of patients with gastroesophageal reflux disease but no HTLES (n = 300), the total and supine periods of distal esophageal acid exposure were significantly lower in the patients with HTLES and abnormal acid exposure. Patients with HTLES frequently present with moderately severe dysphagia and typical reflux symptoms. Approximately one quarter of them have abnormal esophageal acid exposure on pH monitoring. Patients with HTLES have significantly elevated intrabolus and residual relaxation pressures on liquid boluses, suggesting that outflow obstruction is present.
    Keywords: Esophagus ; Sphincter ; Hypertensive ; Obstruction ; Dysphagia ; Medicine
    ISSN: 1091-255X
    E-ISSN: 1873-4626
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