TY - JOUR
T1 - Results of laparoscopic heller myotomy for extreme megaesophagus
T2 - An alternative to esophagectomy
AU - Scott, Paul D.
AU - Harold, Kristi L.
AU - Heniford, B. Todd
AU - Jaroszewski, Dawn E.
PY - 2009/6
Y1 - 2009/6
N2 - Heller myotomy is recognized as the optimal treatment for achalasia. However, treatment of the markedly dilated esophagus has been debated in the literature. Although esophagectomy has been the standard treatment historically, several studies have examined successful treatment of achalasia with laparoscopic Heller myotomy in the setting of a markedly dilated esophagus (>6 cm). Patients with extreme megaesophagus (>10 cm) are often treated with esophagectomy. We report the successful treatment of 4 patients with extreme megaesophagus with laparoscopic Heller myotomy. Three of the 4 patients also had Toupet fundoplication. The average esophageal diameter was 11.2 cm (10 to 12 cm). In addition to severe dysphagia, all patients had preoperative signs, symptoms, and radiographic evidence of esophageal compression of their heart and lungs. All patients reported relief of their preoperative symptoms. Esophagectomy has not been required to maintain adequate clinical results in any of our patients. We conclude that laparoscopic Heller myotomy is an appropriate alternative to esophagectomy and can be offered to patients with extreme megaesophagus.
AB - Heller myotomy is recognized as the optimal treatment for achalasia. However, treatment of the markedly dilated esophagus has been debated in the literature. Although esophagectomy has been the standard treatment historically, several studies have examined successful treatment of achalasia with laparoscopic Heller myotomy in the setting of a markedly dilated esophagus (>6 cm). Patients with extreme megaesophagus (>10 cm) are often treated with esophagectomy. We report the successful treatment of 4 patients with extreme megaesophagus with laparoscopic Heller myotomy. Three of the 4 patients also had Toupet fundoplication. The average esophageal diameter was 11.2 cm (10 to 12 cm). In addition to severe dysphagia, all patients had preoperative signs, symptoms, and radiographic evidence of esophageal compression of their heart and lungs. All patients reported relief of their preoperative symptoms. Esophagectomy has not been required to maintain adequate clinical results in any of our patients. We conclude that laparoscopic Heller myotomy is an appropriate alternative to esophagectomy and can be offered to patients with extreme megaesophagus.
KW - Achalasia
KW - Esophagectomy
KW - Extreme megaesophagus
KW - Laparoscopic Heller myotomy
UR - http://www.scopus.com/inward/record.url?scp=68549096218&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=68549096218&partnerID=8YFLogxK
U2 - 10.1097/SLE.0b013e3181a6dd58
DO - 10.1097/SLE.0b013e3181a6dd58
M3 - Article
C2 - 19542845
AN - SCOPUS:68549096218
SN - 1530-4515
VL - 19
SP - 198
EP - 200
JO - Surgical Laparoscopy, Endoscopy and Percutaneous Techniques
JF - Surgical Laparoscopy, Endoscopy and Percutaneous Techniques
IS - 3
ER -