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

Although rare in children, achalasia can be the cause of debilitating symptoms and growth retardation. During a 4-year period, six patients (mean age 9.9 years) underwent a modified Heller operation (anterior esophageal myotomy) without complication. A concomitant modified Belsey fundoplication was performed in three patients who were judged at the time of operation to be at high risk for postoperative gastroesophageal reflux. Preoperative symptoms of dysphagia, postprandial vomiting, retrosternal pain, and pulmonary complications were eliminated in all patients. Follow-up interviews seven to 48 months (mean 23 months) following operation revealed normal diet and normal growth in all six children, with no recurrence of preoperative symptoms or evidence of gastroesophageal reflux. Technical details which we believe contribute to success in the operative management of pediatric achalasia include the transthoracic approach and the selective performance of complementary anti-reflux procedures.
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PMID:Achalasia in children: treatment by anterior esophageal myotomy (modified Heller operation). 404 56

Between 1970 and 1983, 46 patients were hospitalized in the Vanderbilt University Medical Center and the Metropolitan Nashville General Hospital for treatment of achalasia. All patients had been symptomatic for at least two years. Efforts were made initially to manage most of these patients (40) with periodic esophageal dilatation. This was successful in only six cases (15%). In four instances (10%), patients had esophageal perforation. Thirty patients have had esophagomyotomy (Heller procedure), and 14 of these had an associated antireflux procedure. Three had proximal gastric vagotomy for associated duodenal ulcer disease. Twenty-seven (90%) have had a good result, three died postoperatively, and two elderly patients had postoperative myocardial infarction. The other patient had sepsis after repair of a perforated esophagus. While periodic esophageal dilatation is necessary in patients who may not tolerate an operative procedure, most patients with achalasia are best treated with Heller esophagomyotomy.
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PMID:Surgical management of esophageal achalasia. 407 Nov 36

Result of operative treatment in 196 cases of achalasia was reviewed. The procedures employed include cardiolysis, Heller's extramucosal myotomy, Wendel's cardioplasty, Heyrovsky's esophagocardiostomy, with and without pyloroplasty, cardiac resection and esophagocardioplasty with gastric patch. Follow-up study on 166 cases revealed that the result was classified as good in 99 cases or 59.6 per cent and improved in 46 cases or 27.7 per cent. Overall satisfactory result was obtained in 87.3 per cent. When the result was broken down to groups following three classifications, i.e. according to X-ray, endoscopic and manometric findings, the interesting correlation emerged. Heller's myotomy and esophagocardioplasty with gastric patch gave best results in early stage of achalasia, while in later stage the latter procedure seems to be the operation of choice.
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PMID:Esophagocardioplasty with gastric patch in the treatment of achalasia. 446 69

We reviewed the hospital records of 36 patients who underwent modified Heller's myotomy for achalasia between January, 1961, and December, 1982. There were 18 male and 18 female patients ranging between 17 months and 75 years old. The most frequent symptom was dysphagia, followed by regurgitation of ingested food and weight loss. Modified Heller's myotomy was performed through a transthoracic incision in 35 patients and a transabdominal incision in 1. An antireflux procedure in addition to esophagomyotomy was performed in 20 patients. There was 1 postoperative death. Thirty-three patients were followed up for periods ranging from 9 months to 21 years. The results were considered good in 27, fair in 2, and poor in 4. One of the 4 underwent repeat esophagomyotomy 71/2 years after the initial operation with a good result. The remaining 3 had an antireflux procedure at the time of esophagomyotomy. Because of recurrence of symptoms, esophagogastrostomy was performed in 1 and colon interposition in 2. These results suggest that an antireflux procedure should not be added to modified Heller's operation in the treatment of achalasia.
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PMID:Two decades of experience with modified Heller's myotomy for achalasia. 647 42

Achalasia is a rare unusual lesion of the oesophagus in children under one year of age. The present report describes a boy of 2 months of age suffering from symptoms of oesophageal achalasia and pylorospasmus. Literature is reviewed in order to discuss frequency, pathogenesis and therapy. The infant underwent a successful Heller oesophago-cardio-gastric myotomy completed by fundoplicatio as a reflux barrier.
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PMID:[Achalasia in the neonatal period and early childhood]. 649 79

After a short preface about the main antireflux techniques employed in the treatment and prevention of gastro-oesophageal reflux, the problems involved in the iatrogenous gastro-oesophageal reflux are stated. As no unanimous opinion exists till now in literature about the importance and incidence of reflux after the operation of extramucous cardiomyotomy according to Heller, used in the treatment of achalasia, and after the Parietal Cell Vagotomy, employed in the treatment of duodenal ulcer, an experimental protocol was set up. An experimental research was performed on 16 dogs, subdivided into 3 groups: in the first group (6 dogs) extramucous cardiomyotomy according to Heller and antireflux procedure (antero-lateral hemifundoplication according to Dor-Casolo) were performed; in the second group (6 dogs) Parietal Cell Vagotomy + extramucous cardiomyotomy according to Heller + antero-lateral hemifundoplication according to Dor-Casolo were performed; in the third group (control) the only extramucous cardiomyotomy according to Heller was performed. In the research, articulated in two stages (1st time - operation; 2nd time - remote checking) the following was effected: pressure gauge test; pH-metric test; gastro-oesophageal scintigraphic test with Tc99m; histopathologic test. The experimental results obtained, elaborated by computer, demonstrated: that extramucous cardiomyotomy according to Heller causes serious oesophagitic phenomena, and therefore it should be joined to antireflux procedure; that Parietal Cell Vagotomy (P.C.V.) causes a significant decrease in the tone of L.E.S. (Lower Oesophageal Sphincter); that antero-lateral hemifundoplication according to Dor-Casolo (210 degrees) is effective in its antireflux action even after long time.
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PMID:[Prevention of gastroesophageal reflux. Validity of hemifundoplication according to Cor-Casolo (experimental study)]. 652 81

Since 1979 our policy for management of esophageal perforation has included correction of underlying esophageal disorder as part of the initial treatment in selected cases. A series of 23 patients is presented, of whom 3 were managed conservatively and 20 surgically. The overall mortality rate was 8.7%. Concomitant operation of underlying esophageal disease and perforation was done in eight cases within 12 hours of the perforation. These operations included emergency resection and esophagogastrostomy in five patients (4 with stenosis and 1 with cancer). A Heller myotomy was done in addition to suture repair in two patients with achalasia, and a Belsey Mark IV hernia repair was added to the esophageal suture closure in a patient with gastroesophageal reflux and hiatal hernia. A postoperative fistula healed spontaneously in one of the eight patients, and the early postoperative course was uncomplicated in the other seven. Simultaneous correction of underlying esophageal disease in patients with iatrogenic perforation of the esophagus seems to be safe when perforation is diagnosed at an early stage. Such a radical approach is clearly beneficial.
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PMID:Advisability of concomitant immediate surgery for perforation and underlying disease of the esophagus. 652 78

In six patients with achalasia of the esophagus who previously underwent, one or more times, cardiomyotomy and had a failure of the procedure, we have done a new operation, an abdominal laterolateral anastomosis between the esophagus and the gastric fundus (Heyrowsky), wrapping it up with the stomach to form a genuine fundoplication. The six patients were preoperatively and postoperatively evaluated roentgenographically, endoscopically and manometrically, and the results were good with no reflux, and the drainage effect of the operation was excellent. This technique is a recourse for patients who have a recurrence of dysphagia after the Heller operation, because it has been ineffective, since it sometimes occurs in a rather large megaesophagus.
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PMID:The Heyrowsky operation associated with fundoplication for the treatment of patients with achalasia of the esophagus after failure of the cardiomyotomy. 663 17

To avoid gastroesophageal reflux which is reported to occur in about 4-25 per cent after Heller esophago-cardiomyotomy, a modified gastro-fundoplication was designed using a transabdominal approach. Forty patients with idiopathic esophageal achalasia were subjected to this surgery. There were no serious complications and suppression of dysphagia and gastroesophageal reflux manifestations were excellent.
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PMID:Cardiomyotomy and fundoplication for esophageal achalasia. 666 73

This study was intended to elucidate possible temporal changes of the valve and fundoplication which are formed by modified Mark IV operation as a surgical treatment of esophageal achalasia. Heller's procedure was also studied in terms of its comparison with the above operation. Adult mongrel dogs were operated on as follows and studied at the following postoperative points: Heller's procedure at the forth postoperative week, Modified Mark IV operation at the forth postoperative week, Modified Mark IV operation at the third postoperative month. Postoperative comparative studies were made on temporal changes of the anti-reflux effect by intraesophagogastric pressure and withdrawal pH examinations, measurements of intragastric pressure at reflux through simultaneous evaluation of intraesophageal pH and inner pressures at 3 points, i.e. the esophagus, the high pressure zone and the stomach, and histological and morphological examination. From the above the following conclusion was drawn: The valve formed by modified Mark IV operation showed temporally a shortening tendency, and a significant shortening of the length of valve was observed also in comparisons of values between the forth postoperative week and the third postoperative month. Also in terms of the measurement of inner pressures, a significant decrease was observed in the length and the force of high pressure zone. However, comparisons of the intragastric pressure values at reflux revealed no significant difference in values between the forth week and the third month after the modified Mark IV operation and almost similar anti-reflux effects between both in spite of a shortening of the valve. The above results suggested that more reliable and long-term sustaining of the anti-reflux effect needed more extensive formation of the fundoplication.
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PMID:[An experimental study on temporal changes of post-operative anti-reflux effect by modified Mark IV operation for esophageal achalasia]. 667 66


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