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

Primary motor disorders of the esophagus can be managed surgically with excellent results. Between the years 1972 and 1983, 40 patients were managed by us. The patients ranged in age from 14 to 79 years (mean 36.3 years). Thirty-six patients were managed primarily by the authors and 4 patients secondarily. The distribution of the hypodynamic states were achalasia in 29 patients, vigorous achalasia in 5 patients, and diffuse spasm in 1 patient, whereas the hyperdynamic states were squeeze syndrome in 2 patients, super-squeeze syndrome in 1 patient, and hypertensive lower esophageal sphincter in 2 patients. Of the 36 patients in hypodynamic states, 27 had a modified Heller myotomy and reconstruction of the gastroesophageal junction with a Belsey fundoplication and 9 had only a modified Heller myotomy. There was only one patient with reflux esophagitis. It occurred after myotomy and Belsey fundoplication for a hypertensive lower esophageal sphincter and hiatus hernia. Four patients were managed secondarily for complicated recurrent problems, one with a Belsey fundoplication and three with a jejunal interposition graft. We recommend myotomy, with or without a Belsey fundoplication, for management of primary motor disorders and avoidance of total Nissen fundoplication and a lengthening Collis gastroplasty.
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PMID:Surgical management of primary motor disorders of the esophagus. 674 28

A Heller cardiomyotomy has been realized in 406 cases of achalasia. The indications for operation are defined. Surgery must be preferred to dilatation: the results are favorable in 96% of cases. The failures or so-called failures are detailed. In failures or recurrences due to an insufficient cardiomyotomy, a new myotomy is indicated. Gastro-esophageal reflux is frequently an indication for oesogastric resection. Failures have been observed in 70 cases. The insufficient initial myotomy was completed in 36 cases. The etiology of postmyotomy sclerosis (15 perioesophageal, 3 interstitial) is discussed. Severe peptic oesophagitis, observed in 15 cases, stresses the importance of restoring the anti-reflux mechanism, rather than using a thoracic approach with the risk of a myotomy too limited towards the stomach. Other causes of failures (atypical mega-oesophagus, limited peptic stenosis) are due to an erroneous interpretation of preoperative X-rays, endoscopy and manometric data: in such cases, the original treatment should have been adapted to the lesion. Finally, 8 postoperative oesophageal asystolias and 4 cancers stress the importance of an early myotomy, correctly realized through an abdominal approach.
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PMID:[Surgical treatment of failures or recurrences after Heller cardiomyotomy (author's transl)]. 681 Jun 4

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.
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PMID:Achalasia: diagnosis, management, and clinical course in 16 children. 683 65

Pneumatic dilatation under fluoroscopic control has proven highly successful in the treatment of achalasia. This procedure involves minimal morbidity, local anesthesia is employed, and hospitalization is brief, usually only two days. Surgical myotomy of the lower esophageal sphincter, the Heller procedure, requires a thoracotomy under general anesthesia with its attendant morbidity and at least ten days of hospitalization. In addition, there is a significant incidence of postoperative gastric reflux. We have employed pneumatic dilatation as the sole primary treatment for 30 patients over the last 10 years. The results have been highly successful with marked relief of symptoms and weight gain. Pneumatic dilatation is an effective treatment for achalasia and is recommended as the initial procedure of choice.
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PMID:Pneumatic dilatation as the primary treatment for achalasia. 688 37

A survey is presented of 74 patients with achalasia of the the oesophagus treated surgically at the Royal Prince Alfred Hospital, Sydney, Australia. This survey spans a 27-year period. Thirty-nine patients underwent Heller's operation, 23 (58.9%) had excellent results six months after operation, and 17 (43.5%) still had excellent results more than two years after operation. This group had a high recurrence of symptoms due to oesophageal reflux (30.8%) and the development of strictures (20.5%) at the lower end of the oesophagus. Thirty-five patients underwent Heller's operation together with Nissen fundoplication. Thirty-two patients (91.4%) in this group had excellent results six months after operation, and 30 of these patients (85.7%) still had excellent results more than two years after operation. These results suggest that symptoms of oesophageal reflux and subsequent oesophageal stricture following Heller's operation for achalasia can be considerably reduced, if not prevented, by Nissen fundoplication--a reflux-preventing procedure.
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PMID:A review of 74 patients with oesophageal achalasia: the results of Heller's cardiomyotomy, with and without Nissen fundoplication. 693 23

The reported incidence of esophageal perforation after forceful dilatation in achalasia is between 1-5%. Over the past nine years we have treated five patients with this complication. After demonstrating the perforation with a Gastrografin swallow, a left posterolateral thoracotomy is made. The full-thickness laceration is sutured in two layers. A Heller esophagocardiomyotomy is then performed on the contralateral side of the esophagus. The muscular layer on either side of the esophagocardiomyotomy is mobilized well so as to allow easy closure of the outer muscular layer of the esophagus in the area of the laceration. There were no deaths and minimal morbidity in these five patients, and functional results were excellent. It is concluded that perforations of the esophagus after dilatation in achalasia should be operated on promptly and undergo closure of the laceration with a complimentary esophagocardiomyotomy.
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PMID:Esophageal perforations after forceful dilatation in achalasia. 705 96

While Heller's myotomy has become the accepted operation for achalasia, still, there is no agreement about the indications for and choice of complementary procedures to minimize subsequent acid esophageal reflux. In the instances described in this investigation Heller's operation was accompanied by proximal gastric, or highly selective, vagotomy and anterior fundoplication. Dysphagia was abolished and normal alimentation restored in all but one patient, who was elderly and had an advanced megaesophagus. In every patient after the operation, results of pH-manometry, acid reflux tests and endoscopy demonstrated the absence of both acid reflux and esophagitis.
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PMID:Proximal gastric vagotomy and anterior fundoplication as complementary procedures to Heller's operation for achalasia. 711 62

Most failures or pseudo-failures of Heller's operation are due to an imperfect surgical technique. The procedure should include the entire muscular layer, extend as far upwards as possible and at least two to three cm downwards onto the stomach. Furthermore, it should be associated with an anti-reflux procedure. Eighty-one operations were performed in 70 patients who had previously undergone Heller's operation. Of the 42 patients presenting with recurrent achalasia, 21 had an insufficient Heller procedure upwards, 10 downwards and 11 in depth. Twenty-three patients had peptic esophagitis and three had periesophageal sclerosis. The management of these 70 reoperated patients included 36 iterative esophageal myotomies, 32 resections, four total duodenal diversions and two hiatal reconstructions. Repeated cardiomyotomies gave excellent results in 75% of cases and esophagogastric resection in 79%.
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PMID:Reoperation after Heller's operation for achalasia and other motility disorders of the esophagus: a study of eighty-one reoperations. 711 64

Although oesophagocardiomyotomy has been the method of choice for surgical treatment of achalasia cardiae for several decades, there are still great discrepancies in the technical details of the procedure as performed in different centres. This is one of the main explanations for the diverging results reported, particularly with regard to the incidence of postoperative gastro-oesophageal reflux. Sixty-three patients underwent primary oesophagocardiomyotomy with a total length of 12 cm, including incision of about 2 cm onto the stomach. Forty-one patients were not examined preoperatively for conditions now recognized as predisposing to reflux and were managed with oesophagocardiomyotomy only, except one patient. Eight patients developed severe reflux complications from 1 to 5 years (mean 2 years) after the operation. In 11 out of 22 patients examined preoperatively for such conditions, Heller's operation was combined with an antireflux procedure. The results were good in all patients and pathological gastro-oesophageal reflux was not detected in any of the 22 patients during a follow-up period of 2 to 7 years (mean 4 years). It is concluded that oesophagocardiomyotomy should be combined with an antireflux procedure in selected patients. The indications for an antireflux procedure are discussed.
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PMID:Oesophagocardiomyotomy and antireflux procedures. 715 12

The authors explored the motor behavior of the upper esophageal sphincter in normal subjects and in patients with achalasia of the cardia, in a manometric investigation involving the measurement of intraluminal pressure both with axial and with radial catheters. The former were used to assess motor coordination between the various segments of the esophagus; the latter for recording basal pressure along various diameters. The data concerning pressure at rest, relaxation time, and motor coordination relative to adjacent segments, were then compared with the corresponding data obtained in a group of patients treated surgically by Heller cardiomyotomy and Dor, antireflux esophagoplasty, and then with those obtained in a group of normal subjects. Statistical processing of data by the T test of STUDENT failed to reveal any significant differences between the three groups being compared. This is taken to mean complete motor independence of the upper esophageal sphincter in achalasia in relation to the remaining segments of the esophagus, whereas these segments are themselves subject to considerable variations of pressure and motility.
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PMID:[Manometric study of the upper esophageal sphincter in normal subjects and in patients with achalasia of the cardia]. 723 54


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