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

A technique of laparoscopic cardiomyotomy is described. The procedure has been performed in a patient with manometrically confirmed classical achalasia with complete relief of episodic total dysphagia and no untoward symptoms including reflux. The procedure was followed by minimal postoperative discomfort and the patient was discharged on the third postoperative day. Laparoscopic cardiomyotomy has the advantage of diminished surgical trauma with accelerated recovery, constitutes definitive therapy comparable to standard myotomy, and by being less disruptive of the lower oesophageal fixation it is prone to precipitate gastro-oesophageal reflux.
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PMID:Laparoscopic cardiomyotomy for achalasia. 183 41

The long-term results after Heller's myotomy for oesophageal achalasia were illustrated by questionnaire sent to 38 out of the original 47 patients submitted to operation during the ten-year period 1.7.1973-30.6.1983. Nine patients had died from other causes during the follow-op period. The minimum period of observation for the remaining patients was five years and the mean period of observation was 10.3 years. Thirty-six questionnaires were returned (95%). 75% of the patients were satisfied with the results of operation but only 25% were symptom-free. The commonest symptom was dysphagia (56%) followed by reflux problems (50%). Every third patient had discomfort from the scar. All of the 25% of the patients who were not satisfied with the result of operation had dysphagia. On the basis of these observations, the authors consider that Heller's myotomy should be reserved for patients on whom dilatation treatment has proved unsatisfactory.
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PMID:[Treatment of esophageal achalasia using Heller's method]. 230 50

During a 15-year period, 62 patients were treated for achalasia of the esophagus. Pneumatic dilation (PD) had been performed initially in 46 and was successful in 23; failures were due to acute perforation of the esophagus, persistent dysphagia, or pathologic gastroesophageal reflux. Esophagomyotomy alone (EM) was performed in 19 individuals resulting in definite improvement in 12; four patients had moderate reflux or dysphagia, and three of these required another surgical procedure. An extended myotomy with an antireflux procedure (M-NF) was performed in 13 patients with symptomatic relief in 12; one patient required reconstruction of a too-tight fundoplication that caused persistent dysphagia. The advantages of pneumatic dilation were the ease of performance, patient acceptability, and an overall efficacy of 50%. Definitive surgical therapy, while more predictably effective in relieving dysphagia, was considerably more expensive in terms of patient discomfort and time. When pathologic reflux was present following a previous procedure, the M-NF was performed; obstruction of the esophagus did not occur if the fundoplication was "floppy." The M-NF deserves consideration as the surgical procedure of choice for achalasia.
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PMID:Achalasia of the esophagus. Treatment controversies and the method of choice. 370 29

The treatment of esophageal achalasia has been controversial for many years. Even if a myotomy performed through a left thoracotomy gives better results than pneumatic dilatation, the fear of an operation with the associated postoperative pain and disability has kept patients away from this form of treatment. Minimally invasive surgery allows the same results obtained with open surgery, with a short hospital stay, minimal postoperative discomfort, and a fast recovery time. A thoracoscopic or laparoscopic Heller's myotomy should be considered today the primary form of treatment for esophageal achalasia.
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PMID:Thoracoscopic and laparoscopic Heller's myotomy in the treatment of esophageal achalasia. 757 74

A 65-year-old woman was admitted to our hospital because of pulmonary nodules, about 3 cm in diameter in the right upper lobe accompanied by pleural indentation, and 5 mm in diameter in the left middle lung field, revealed by chest X-ray. She had no clinical signs or symptoms except achalasia-like discomfort swallowing. Results of physical examinations were within normal limits. A specimen obtained from the nodule in right S2 by transbronchial biopsy showed noncaseating epithelioid granuloma containing asteroid bodies, and negative staining for acid-fast bacilli. No malignant cells were found in the specimen. Bacteriological examination of a bronchial lavage specimen was negative for pyogenic bacteria, mycobacteria and fungi. A PPD skin test was negative. BALF revealed an increase of lymphocytes and elevation of CD4/CD8 ratio. Fifteen years previously, the patient had been diagnosed as having sarcoidosis by scalene node biopsy, and had been treated with steroid therapy. Pulmonary nodules associated with pleural indentation in sarcoidosis is relatively rare, and is usually due to malignancy such as lung cancer. This possibility was ruled out clinically in the present case. Therefore, it was concluded that the pulmonary nodules in this case were due to the sarcoidosis itself.
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PMID:[A case of sarcoidosis presenting as pulmonary nodules associated with pleural indentation fifteen years after onset]. 827 63

Achalasia, nutcracker oesophagus and diffuse oesophageal spasm are primary oesophageal motility disorders whose treatment has been substantially impacted by the advent and development of minimally invasive surgery. Although several studies had shown that oesophageal myotomy was effective in the treatment of several of these disorders, particularly in the more advanced stages, many of the patients who could have benefited from an operation were instead with medications or balloon dilation, sometimes despite repeated failures of this form of therapy. To a certain extent, this reflected patient and physicians' concerns with the post-operative discomfort and the long recovery time inevitably associated with the performance of a thoracotomy or laparotomy. Today, however, we and others have shown that minimally invasive techniques allow an operation to be performed with the same excellent results provided by open surgery, but with a shorter hospital stay, minimal post-operative discomfort, and faster return to work. We performed our first thoracoscopic myotomy for achalasia in January of 1991, initially using a technique developed by Dr. Cuschieri, which we modified as we gained experience. Subsequently, we extended the same technique to the treatment of diffuse oesophageal spasm and nutcracker oesophagus. This report describes our experience at the University of California at San Francisco and the University of Washington in Seattle for the diagnostic and therapeutic approach to patients with primary oesophageal motility disorders.
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PMID:Endoscopic surgical treatment of primary oesophageal motility disorders. 876 73

Achalasia is an uncommon condition in children. The authors report on two children who were evaluated and treated with laparoscopic esophagomyotomy. A 6-port technique was used, with five 5-mm ports and one 10-mm port. During the procedure, esophagoscopy was performed simultaneously, which provided esophageal distension for easier dissection and aided the surgeon by documenting when a complete myotomy had been accomplished. The patients' symptoms have resolved, and no postoperative complications have developed. Laparoscopic esophagomyotomy can be performed safely in children and is an effective approach for treatment of this disorder. Its advantages over the open approach include shorter hospitalization and less discomfort.
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PMID:Laparoscopic esophagomyotomy for achalasia in children. 886 91

Extramucosal myotomy involving the external longitudinal and internal circular layers of the musculature of the esophagus represent the surgical therapy in patients with dysphagia and regurgitation or with angina-like chest pain secondary to functional abnormalities of the musculature of the esophagel body and sphincters. Surgery has a palliative function, because cures symptoms and complication such a diverticula, but not the disease. Modern surgical techniques also prevent recurrence of symptoms and complications are minimal with better long-term results than conservative therapy. Myotomy of the lower esophageal sphincter extended to the distal part of the esophageal body (Heller's operation) is performed as first choice or following insucces of dilatation in patients with primary achalasia of the esophagus, using a trans-abdominal or a trans-thoracic approach. Myotomy of the upper esophageal sphincter is indicated in patients with Zenker's diverticulum following diverticulectomy or diverticulopessy. Segmental myotomies are performed after diverticulectomy in patients with epiphrenic pulsion diverticula. Trans-thoracic "long" esophageal myotomy performed from the thoracic portion of the lower esophageal sphincter to the aortic arch is indicated in patients with diffuse esophageal spasm and nutcracker esophagus and sometimes in patients with aspecific abnormalities of the esophageal motor function associated with diverticula. Circular miotomies limited to the external longitudinal layer of the esophageal musculature can be performed at the level of anastomosis in order to gain tissue and reduce tissutal tension. The recent introduction of the endoscopic surgery allowed some of these operations to be performed through minimally invasive approaches. Therefore laparoscopic and thoracoscopic Heller's myotomy is feasible with clinical and functional results similar to those obtained with traditional open approach and with less postoperative discomfort and shorter hospital stay. This paper deals with the indications and surgical techniques of myotomies of the esophageal body both limited and extended to the lower esophageal sphincter.
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PMID:[Myotomy of the esophageal body]. 894 93

Esophageal achalasia (EA) has been historically treated by esophageal dilatation or myotomy with or without fundoplication. Botulinum toxin (Botox-Allergan) use in pediatric EA has not been previously described. The authors' objective was to observe the efficacy of botulinum toxin injection into the lower esophageal sphincter (LES) for EA. An 11-year-old boy presented with a 9-month history of frequent pneumonia, productive cough, and a 1-year history of chest discomfort and odynophagia. Chest radiograph showed changes compatible with aspiration. Upper gastrointestinal (UGI) series showed typical narrowing of the LES, and 24-hour pH study showed no reflux. Esophageal manometry showed classic findings of achalasia. An upper gastrointestinal endoscopy was performed showing a huge volume of retained food. A direct four-quadrant injection was performed with a total of 100 U of botulinum toxin into the LES. UGI series showed improvement in esophageal emptying. Esophageal manometry showed impressive improvement in LES pressure (preinjection, 44.1 mm Hg to postinjection mean of 16.6 mm Hg), percent relaxation (preinjection, 30% to postinjection, 58.8%), and duration of relaxation (preinjection, 1.9 seconds to postinjection, 11 seconds). The patient has not had any further respiratory symptoms, chest pain, or odynophagia in 8 months of follow-up. Botulinum toxin injection is simple and effective for EA and merits its study in a prospective manner in the pediatric population.
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PMID:Botulinum toxin use in pediatric esophageal achalasia: a case report. 920 Jan

During the last decade, minimally invasive surgery has replaced open surgery in the treatment of esophageal achalasia. This new approach, in fact, determines results similar to the open approach, but is associated to a shorter hospital stay, minimal postoperative discomfort, and faster return to regular activity. Between 1991 and 1998, 168 patients underwent a cardiomyotomy by minimally invasive techniques. Good or excellent results were obtained in 85% of patients after thoracoscopic myotomy, and 93% of patients after laparoscopic myotomy and partial fundoplication. The latter procedure was followed by a lower incidence of postoperative gastroesophageal reflux (60% versus 17%). Laparoscopic Heller myotomy and partial fundoplication has emerged as the procedure of choice for esophageal achalasia, and it should be considered today the primary form of treatment for this disease.
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PMID:Cardiomyotomy. 1068 51


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