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Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

With the use of gastroesophageal withdrawal pH curve, pathophysiology after various surgical procedures for achalasia of the esophagus was investigated experimentally from the view point of postoperative reflux. A total of 68 dogs were divided into four groups and were prepared with proximal gastrectomy with end-to-end esophagogastrostomy, Wendel procedure, Heller procedure and Fundic patch operation, respectively. In the group with Fundic patch operation, efficacy of the flap valve, mucosal valve and fundoplication was also evaluated preparing them in various sizes. The results obtained may be summarized as follows: 1) Withdrawal pH measurement is a sentive mean to detect the gastroesophageal reflux. 2) Proximal gastrectomy with end-to-end esophagogastrostomy and Wendel procedure yielded worst results with severe gastroesophageal reflux. On the contrary, Fundic patch operation best controlled the gastroesophageal reflux. 3) Gastroesophageal reflux could be prevented by the Fundic patch operation with the flap valve 6 cm in length and fundoplication enclosing around 1/2 to 2/3 circumference of the distal esophagus.
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PMID:[Evaluation of antireflux effect of fundic patch operation by withdrawal pH curve (author's transl)]. 2 21

Modified Heller's esophagomyotomy for achalasia of the esophagus was done in 145 patients at Henry Ford Hospital, Detroit, from 1951 to 1977. Information on current symptoms was obtained for 121 patients from a detailed questionnaire that was sent to all patients, from personal interviews, or from data obtained from patients' clinical records. Average period of follow-up was 85 months. Actuarial analysis of postoperative symptoms showed an incidence of reflux of 24% after one year and 48% after ten years; incidence of relief of dysphagia was 89% of all patients after one year and 81% after ten years. Continual surveillance of patients after esophagomyotomy must be stressed. Dissatisfaction with the results of this procedure prompted us to recommend that an antireflux operation be performed at the time of the initial procedure.
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PMID:Long-term results of esophagomyotomy for achalasia of esophagus. 46 8

Four cases of H-type tracheoesophageal fistula are reported. The patients all had chronic aspiration from the esophagus. Although serious symptoms were present in all, definitive diagnoses were not made until the patients had reached 1, 6, 12, and 50 years of age, because ordinary radiologic methods failed to establish the diagnosis. The angulation of the fistula usually prevents contrast medium in the esophagus from entering the trachea, especially with the subject upright. On the other hand, air easily passes from the trachea to the esophagus, eventually producing megaesophagus which may be confused with the picture of achalasia. An ill-advised Heller esophagomyotomy was done on 1 patient. All 4 patients eventually had successful closure of the fistulas. Three operations were by the transthoracic route, and 1 high fistula in an infant was closed through a cervical approach.
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PMID:Diagnosis and surgical treatment of "H-type" tracheoesophageal fistulas. 51 80

Heller's cardiomyotomy or one of the modifications are not sufficient in the third stage of achalasia. Additional surgery is required for reversion of the dilated and elongated esophagus. Two patients with third-grade achalasia were treated by cardiomyotomy in combined with esophagomyoplication and followed up for one year. The results were evaluated clinically, radiologically, manometrically, pH-metrically, and endoscopically. We concluded that esophagomyoplication satisfactorily completes cardiomyotomy in cases of third-grade achalasia.
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PMID:[Esophageal myoplicature in the treatment of decompensated achalasia]. 52 99

In the light of three cases of esophageal carcinoma developing on a pre-existing idiopathic megaesophagus the authors examine etiopatological, clinical and terapeutic problems related to this association. They believe that carcinoma of the esophagus tends to be a complication of cardiospasm in patients inadequately treated for the primary condition. Early diagnosis and an adequate Heller operation for cardiospasm will lessen the chance of cancer developing in megaesophagus with stasis. When finally diagnosed, this variety of esophageal carcinoma has an extremely poor prognosis. An even more important claim upon the clinician is to be alert to the hazards of continued stasis in megaesophagus and to devise earlier techniques of recognition, including more frequent recourse to biopsy during esophagoscopy.
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PMID:[Association of idiopathic megaesophagus and carcinoma]. 54 Mar 69

The authors undertook a retrospective study of a series of 17 cases of idiopathic megaoesophagus seen over a period of 25 years in two paediatric surgery departments. Age distribution was regularly between 20 months and 15 years. No neonatal nor familial forms were seen. Symptoms were dominated by regurgitation and dysphagia. Weight loss was an almost constant feature. Heller's operation, via an abdominal approach with retro-oesophageal valve of the tuberosity fixed to both edges of the myotomy, was the operation proposed. In one case of recurrent megaoesophagus operated upon elsewhere a Thal operation gave a good result with a follow up of 8 years. Immediate clinical and radiological results were favourable in the great majority of cases : 16 cases out of 17. Long term results (follow up of more than 5 years in 8 patients) were also favourable. However one patient was sometimes troubled by regurgitations due to persistent achalasia and a grave failure occured in a patient who five years after a Heller operation developed a peptic stenosis of the lower oesophagus. No recurrence of megaoesophagus was seen. The authors emphasise the importance of the prevention of gastro-oesophageal reflux and the value of oesophagoscopy and of manometry in cases where the result of a Heller's operation is imperfect.
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PMID:[Idiopathic megaoesophagus in the child. A series of 17 cases treated surgically (author's transl)]. 54 68

A 31 year-old female initially presented with clinical features consistent with achalasia, which were relieved by the Heller procedure. Several years later manometric tracings excluded the diagnosis of achalasia, and suggested a motility disorder of the esophageal body. A long esophageal myotomy was performed and was followed by a marked improvement in symptoms and a normalization of the manometric tracing. Multiple histologic sections from the surgical specimen revealed the absence of ganglion cells, a feature not previously described in motor disorders other than achalasia. These findings suggest that classification of esophageal motility disorders on the basis of manometric and histologic findings might not be possible and that surgical treatment should be directed towards the predominant symptoms.
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PMID:[Unusual esophageal motility disorder (author's transl)]. 63 8

A standardized method of performing pneumatic dilatation for the treatment of achalasia is described. Twenty-five patients were treated in this manner and 80% had excellent results. There was minimal morbidity and no mortality. Pneumatic dilatation is recommended as the primary procedure for achalasia as it is a simple and safe procedure which avoids unnecessary surgery. Local topical anesthesia, rather than general, is utilized and hospitalization time is two days, rather than the 14 days required following surgery. The Heller operation can be performed when pneumatic dilatation is unsuccessful.
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PMID:Case for pneumatic dilatation in achalasia. 68 96

1. Esophageal achalasia is a rare disease of unknown origin that occurs with the same frequency in both sexes. 2. During the preoperative workup as well as the postoperative time the following studies should be performed: upper GI series, esophageal manometry and endoscopy with biopsy. 3. In most instances conservative treatment with dilations only provides temporal relief of the symptoms and moreover, is not exempt from complications; it should be employed only in incipient achalasia, in patients who refuse to be operated upon and in those whose general conditions make surgery inadvisable. 4. Surgery can provide a permanent cure for the symptomatology in the majority of the patients, with a very low mortality and morbidity; an operation should be performed early in those who retain more than 10 mls. in the esophagus with persistence of the symptomatology as well as in those patients in whom cancer is suspected. 5. A modified Heller type operation, with abdominal approach with gastrostomy, diaphragmatic hernioplasty and an anti-reflux procedure and when necessary a piloroplasty is the treatment of choice for esophageal achalasia yielding good results in 88.8% of the cases. It should be noted that the degree of postoperative gastroesophageal regurgitation is directly related to the extent to which the gastric incisons is extended below the esophageal-gastric junction.
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PMID:[Surgical treatment of achalasia. Analysis of 27 cases]. 71 47

Antireflux effect of various operations for achalasia of the esophagus was investigated with the use of the manometric study. Operative procedures subjected to the present comparative study were proximal gastrectomy with end-to-end esophagosgastrostomy, Wendel procedure, Heller procedure and Fundic patch operation, each prepared in four mongrel dogs. Incidence of postoperative reflux with possible esophagitis was greatest in proximal gastrectomy followed by Wendel and Heller procedure. Fundic patch operation well prevented the reflux with greater values of pressure as well as dimension of the lower esophageal sphincter than those of the control series. In other series of experiments in dogs, an attempt was made to reveal the rationale of the effective valvular mechanism of the Fundic patch operation preparing various sizes of the valve. When compared by the manometric study, Fundic patch procedure with an incision of 6 cm in length, formation of the artificial mucosal valve and two thirds enclosure of the distal esophagus with the fundus like fundoplication sufficiently prevented the reflux. Preparation of the valve smaller in size accelerated the incidence of postoperative reflux.
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PMID:[Manometric studies on antireflux effect of fundic patch operation]. 91 41


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