Laparoscopic esophageal myotomy for achalasia

Factors affecting functional results

Subrato Deb, Claude Deschamps, Mark S. Allen, Francis C. Nichols, Stephen D. Cassivi, Brian S. Crownhart, Peter C. Pairolero

Research output: Contribution to journalReview article

47 Citations (Scopus)

Abstract

Background. We reviewed our experience and analyzed factors affecting functional results after laparoscopic esophageal myotomy (LEM) for achalasia. Methods. From January 1996 through October 2003, the records of 211 patients (110 men and 101 women) who had LEM for achalasia were reviewed, and factors affecting morbidity and functional results were analyzed. Results. Median age was 47 years (range, 12 to 85). One hundred and twenty-five patients (59%) had prior esophageal dilatation and/or botulinum toxin injection and 19 (9%) had a prior myotomy. A partial fundoplication was performed in 198 patients (94%); posterior in 135 and anterior in 63. Median operative time was 208 minutes (range, 90 to 527). Intraoperative complications occurred in 37 patients (17.5%), and included mucosal perforation in 32, pneumothorax in 2, and retained needle, splenic capsular tear, and gastric short vessel bleeding in 1 each. Five patients (2%) required conversion to an open procedure. Postoperative complications occurred in 17 patients (8%) including 2 patients who required reoperation for leak. There were no perioperative deaths. Median hospitalization was 3 days (range, 1 to 48). Follow-up was complete in 167 patients (79%) and ranged from 1 to 70.5 months (median, 5.3). Functional results were classified as excellent in 105 patients (63%), good in 43 (26 %), and fair or poor in 19 (11%). Previous esophageal surgery for achalasia adversely affected functional results (p = 0.0139). Preoperative bougie dilatation (p = 0.9851), pneumatic dilatation (p = 0.8548), botulinum toxin injection (p = 0.1724), and the type of fundoplication (p = 0.5904) did not affect functional results. Preoperative bougie dilatation (p = 0.441), pneumatic dilatation (p = 0.1060), and botulinum toxin injection (p = 0.3938) did not affect the incidence of intraoperative perforation. As experience is gained, the incidence of intraoperative complications has decreased significantly (p = 0.0075). Conclusions. Laparoscopic myotomy for achalasia is safe and effective in the majority of patients. The incidence of intraoperative complications decreases as experience is gained. Preoperative endoscopic treatment does not preclude successful surgical outcome. Excellent or good functional results are achieved in the majority of patients although previous surgical treatment adversely affects functional results.

Original languageEnglish (US)
Pages (from-to)1191-1195
Number of pages5
JournalAnnals of Thoracic Surgery
Volume80
Issue number4
DOIs
StatePublished - Oct 2005

Fingerprint

Esophageal Achalasia
Dilatation
Botulinum Toxins
Intraoperative Complications
Fundoplication
Injections
Incidence
Conversion to Open Surgery
Pneumothorax
Operative Time
Tears
Reoperation
Needles
Stomach
Hospitalization
Hemorrhage
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Deb, S., Deschamps, C., Allen, M. S., Nichols, F. C., Cassivi, S. D., Crownhart, B. S., & Pairolero, P. C. (2005). Laparoscopic esophageal myotomy for achalasia: Factors affecting functional results. Annals of Thoracic Surgery, 80(4), 1191-1195. https://doi.org/10.1016/j.athoracsur.2005.04.008

Laparoscopic esophageal myotomy for achalasia : Factors affecting functional results. / Deb, Subrato; Deschamps, Claude; Allen, Mark S.; Nichols, Francis C.; Cassivi, Stephen D.; Crownhart, Brian S.; Pairolero, Peter C.

In: Annals of Thoracic Surgery, Vol. 80, No. 4, 10.2005, p. 1191-1195.

Research output: Contribution to journalReview article

Deb, S, Deschamps, C, Allen, MS, Nichols, FC, Cassivi, SD, Crownhart, BS & Pairolero, PC 2005, 'Laparoscopic esophageal myotomy for achalasia: Factors affecting functional results', Annals of Thoracic Surgery, vol. 80, no. 4, pp. 1191-1195. https://doi.org/10.1016/j.athoracsur.2005.04.008
Deb, Subrato ; Deschamps, Claude ; Allen, Mark S. ; Nichols, Francis C. ; Cassivi, Stephen D. ; Crownhart, Brian S. ; Pairolero, Peter C. / Laparoscopic esophageal myotomy for achalasia : Factors affecting functional results. In: Annals of Thoracic Surgery. 2005 ; Vol. 80, No. 4. pp. 1191-1195.
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abstract = "Background. We reviewed our experience and analyzed factors affecting functional results after laparoscopic esophageal myotomy (LEM) for achalasia. Methods. From January 1996 through October 2003, the records of 211 patients (110 men and 101 women) who had LEM for achalasia were reviewed, and factors affecting morbidity and functional results were analyzed. Results. Median age was 47 years (range, 12 to 85). One hundred and twenty-five patients (59{\%}) had prior esophageal dilatation and/or botulinum toxin injection and 19 (9{\%}) had a prior myotomy. A partial fundoplication was performed in 198 patients (94{\%}); posterior in 135 and anterior in 63. Median operative time was 208 minutes (range, 90 to 527). Intraoperative complications occurred in 37 patients (17.5{\%}), and included mucosal perforation in 32, pneumothorax in 2, and retained needle, splenic capsular tear, and gastric short vessel bleeding in 1 each. Five patients (2{\%}) required conversion to an open procedure. Postoperative complications occurred in 17 patients (8{\%}) including 2 patients who required reoperation for leak. There were no perioperative deaths. Median hospitalization was 3 days (range, 1 to 48). Follow-up was complete in 167 patients (79{\%}) and ranged from 1 to 70.5 months (median, 5.3). Functional results were classified as excellent in 105 patients (63{\%}), good in 43 (26 {\%}), and fair or poor in 19 (11{\%}). Previous esophageal surgery for achalasia adversely affected functional results (p = 0.0139). Preoperative bougie dilatation (p = 0.9851), pneumatic dilatation (p = 0.8548), botulinum toxin injection (p = 0.1724), and the type of fundoplication (p = 0.5904) did not affect functional results. Preoperative bougie dilatation (p = 0.441), pneumatic dilatation (p = 0.1060), and botulinum toxin injection (p = 0.3938) did not affect the incidence of intraoperative perforation. As experience is gained, the incidence of intraoperative complications has decreased significantly (p = 0.0075). Conclusions. Laparoscopic myotomy for achalasia is safe and effective in the majority of patients. The incidence of intraoperative complications decreases as experience is gained. Preoperative endoscopic treatment does not preclude successful surgical outcome. Excellent or good functional results are achieved in the majority of patients although previous surgical treatment adversely affects functional results.",
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T2 - Factors affecting functional results

AU - Deb, Subrato

AU - Deschamps, Claude

AU - Allen, Mark S.

AU - Nichols, Francis C.

AU - Cassivi, Stephen D.

AU - Crownhart, Brian S.

AU - Pairolero, Peter C.

PY - 2005/10

Y1 - 2005/10

N2 - Background. We reviewed our experience and analyzed factors affecting functional results after laparoscopic esophageal myotomy (LEM) for achalasia. Methods. From January 1996 through October 2003, the records of 211 patients (110 men and 101 women) who had LEM for achalasia were reviewed, and factors affecting morbidity and functional results were analyzed. Results. Median age was 47 years (range, 12 to 85). One hundred and twenty-five patients (59%) had prior esophageal dilatation and/or botulinum toxin injection and 19 (9%) had a prior myotomy. A partial fundoplication was performed in 198 patients (94%); posterior in 135 and anterior in 63. Median operative time was 208 minutes (range, 90 to 527). Intraoperative complications occurred in 37 patients (17.5%), and included mucosal perforation in 32, pneumothorax in 2, and retained needle, splenic capsular tear, and gastric short vessel bleeding in 1 each. Five patients (2%) required conversion to an open procedure. Postoperative complications occurred in 17 patients (8%) including 2 patients who required reoperation for leak. There were no perioperative deaths. Median hospitalization was 3 days (range, 1 to 48). Follow-up was complete in 167 patients (79%) and ranged from 1 to 70.5 months (median, 5.3). Functional results were classified as excellent in 105 patients (63%), good in 43 (26 %), and fair or poor in 19 (11%). Previous esophageal surgery for achalasia adversely affected functional results (p = 0.0139). Preoperative bougie dilatation (p = 0.9851), pneumatic dilatation (p = 0.8548), botulinum toxin injection (p = 0.1724), and the type of fundoplication (p = 0.5904) did not affect functional results. Preoperative bougie dilatation (p = 0.441), pneumatic dilatation (p = 0.1060), and botulinum toxin injection (p = 0.3938) did not affect the incidence of intraoperative perforation. As experience is gained, the incidence of intraoperative complications has decreased significantly (p = 0.0075). Conclusions. Laparoscopic myotomy for achalasia is safe and effective in the majority of patients. The incidence of intraoperative complications decreases as experience is gained. Preoperative endoscopic treatment does not preclude successful surgical outcome. Excellent or good functional results are achieved in the majority of patients although previous surgical treatment adversely affects functional results.

AB - Background. We reviewed our experience and analyzed factors affecting functional results after laparoscopic esophageal myotomy (LEM) for achalasia. Methods. From January 1996 through October 2003, the records of 211 patients (110 men and 101 women) who had LEM for achalasia were reviewed, and factors affecting morbidity and functional results were analyzed. Results. Median age was 47 years (range, 12 to 85). One hundred and twenty-five patients (59%) had prior esophageal dilatation and/or botulinum toxin injection and 19 (9%) had a prior myotomy. A partial fundoplication was performed in 198 patients (94%); posterior in 135 and anterior in 63. Median operative time was 208 minutes (range, 90 to 527). Intraoperative complications occurred in 37 patients (17.5%), and included mucosal perforation in 32, pneumothorax in 2, and retained needle, splenic capsular tear, and gastric short vessel bleeding in 1 each. Five patients (2%) required conversion to an open procedure. Postoperative complications occurred in 17 patients (8%) including 2 patients who required reoperation for leak. There were no perioperative deaths. Median hospitalization was 3 days (range, 1 to 48). Follow-up was complete in 167 patients (79%) and ranged from 1 to 70.5 months (median, 5.3). Functional results were classified as excellent in 105 patients (63%), good in 43 (26 %), and fair or poor in 19 (11%). Previous esophageal surgery for achalasia adversely affected functional results (p = 0.0139). Preoperative bougie dilatation (p = 0.9851), pneumatic dilatation (p = 0.8548), botulinum toxin injection (p = 0.1724), and the type of fundoplication (p = 0.5904) did not affect functional results. Preoperative bougie dilatation (p = 0.441), pneumatic dilatation (p = 0.1060), and botulinum toxin injection (p = 0.3938) did not affect the incidence of intraoperative perforation. As experience is gained, the incidence of intraoperative complications has decreased significantly (p = 0.0075). Conclusions. Laparoscopic myotomy for achalasia is safe and effective in the majority of patients. The incidence of intraoperative complications decreases as experience is gained. Preoperative endoscopic treatment does not preclude successful surgical outcome. Excellent or good functional results are achieved in the majority of patients although previous surgical treatment adversely affects functional results.

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