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01-06-2009 | SSAT Plenary Presentation

Minimally Invasive Surgical Treatment of Sigmoidal Esophagus in Achalasia

Authors: Matthew J. Schuchert, James D. Luketich, Rodney J. Landreneau, Arman Kilic, Yun Wang, Miguel Alvelo-Rivera, Neil A. Christie, Sebastien Gilbert, Arjun Pennathur

Published in: Journal of Gastrointestinal Surgery | Issue 6/2009

Abstract

Background

The appropriate surgical intervention for sigmoidal esophagus in the setting of achalasia remains controversial. The objective of this study is to review our experience with minimally invasive myotomy (MIM) and minimally invasive esophagectomy (MIE) in the treatment of these patients.

Methods

We reviewed the records of 30 patients (19 men, 11 women); mean age 59.1 years (range 25–83 years) who underwent MIM (n = 24) or MIE (n = 6). Primary variables included perioperative and long-term outcomes. Univariate and multivariate analyses were performed to identify clinical variables predictive of myotomy failure.

Results

The operative mortality was zero and median hospital stay was 2 days (MIM) and 7 days (MIE). On follow-up (mean 30.5 months), nine (37.5%) patients undergoing primary MIM had failure requiring redo myotomy (n = 1) or esophagectomy (n = 8). Univariate analysis showed that previous myotomy and duration of symptoms were significant predictors of failure of MIM, with patient age trending toward significance. Multivariate analysis showed age and longer symptom duration to be significant.

Conclusions

MIM affords symptomatic improvement in many patients. Age and symptom duration may be preoperative indicators of MIM failure. MIE offers similar symptom relief but is associated with a longer hospital stay. Further prospective studies are required to define the optimum treatment algorithm in the management of these patients.

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Title: Minimally Invasive Surgical Treatment of Sigmoidal Esophagus in Achalasia
Authors: Matthew J. Schuchert
James D. Luketich
Rodney J. Landreneau
Arman Kilic
Yun Wang
Miguel Alvelo-Rivera
Neil A. Christie
Sebastien Gilbert
Arjun Pennathur
Publication date: 01-06-2009
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 6/2009
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-009-0843-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Minimally Invasive Surgical Treatment of Sigmoidal Esophagus in Achalasia

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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