Extract of the full text
of this article appear below.
Are the results of myotomy altered by previous dilatations?
J.C. Chiocca, G.B. Salis (Buenos Aires)
In our exprience [1] on 120 patients with achalasia of the esophagus treated by pneumatic dilatation (PD), 21 had a recurrence of the disease and underwent surgical treatment, 15 because of 2 therapeutic failures, and 6 who refused a second dilatation. There were 10 females (R: 21-58, X 37.6 years) and 11 males (R: 26-68, X 43.5 years). Fourteen patients were subjected to Heller cardiomyotomy, and 7 were treated by Heller's procedure plus partial fundoplication. After an average follow-up of 3.5 years, 20 patients (95.2%) are doing well. One patient who had a Heller cardiomyotomy, developed gastroesophageal reflux disease (GERD) complicated by Barrett's epithelium, and is currently on proton pump inhibitors.
Based on our experience, we conducted a bibliographic search of the last 5 years with the following findings. Pinotti [2] reported on 92 patients who experienced previous pneumatic dilatation failures and were treated thereafter by myotomy and fundoplication with "no statistically significant difference found on comparing the cases with and without previous dilatation (excellent results in 83.9%)". Ferguson [3], in a recent paper on 44 patients with failure from 1 to 3 previous PDs, reports excellent or good results with myotomy and fundoplication in 88% of the cases. Korn [4] shows similar results (good or excellent in 87.5%) with the same combined surgical treatment in 40 achalasia patients with previous failure to a median of 2 pneumatic dilatations. Martins [5] reports on a group of chagasic megaesophagus which presented 30 recurrences of pneumatic dilatation, which were treated by surgery with good results in 23 cases (76.6%). Parkman [6] reported as well, that 15 patients with failure to pneumatic dilatation were submitted to surgical myotomy with good clinical and X-ray results in 100% of the cases. Similar experience has been reported by Maurer [7] on 12 patients with failure to one or more preoperative pneumatic dilatations, who did well after extramucosal myotomy combined with Dor's semifundoplication; and by Tandon [8] in 2 patients (Heller), and Abid [9] in one Heller procedure. On the contrary, Victor's paper [10] was the only one reported in the period mentioned above which addressed the case of "a female aged 46 dilated on 2 occasions with failure, in whom at surgery the muscle fibers were found disrupted, with submucosal adhesions and friable mucosa", precluding Heller's myotomy. She was finally treated by a Mickulicz's procedure.
...
only available for members ()
|
