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Evaluation and Treatment of Patients with Recurrent Dysphagia After Heller Myotomy

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Achalasia

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Abstract

A laparoscopic Heller myotomy (LHM) with partial fundoplication is considered today in most centers in the United States and abroad the recommended surgical treatment modality for achalasia patients. Even though the success rate of LHM is initially very high, some patients eventually experience recurrent dysphagia. In these cases, a careful work-up is mandatory to identify the cause of the failure and to design a tailored treatment plan by either endoscopy or surgery. The best outcomes are achieved by a team approach, in Centers where radiologists, gastroenterologists and surgeons have experience in the diagnosis and treatment of this disease.

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References

  1. Patti MG, Pellegrini CA, Horgan S, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg. 1999;230:587–93.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Patti MG, Molena D, Fisichella PM, et al. Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg. 2001;136:870–7.

    Article  CAS  PubMed  Google Scholar 

  3. Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg. 2003;138:490–5.

    Article  PubMed  Google Scholar 

  4. Patti MG, Fisichella PM, Perretta S, et al. Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg. 2003;196:698–703.

    Article  PubMed  Google Scholar 

  5. Richards WO, Torquati A, Holzman MD, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–12.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Wright AS, Williams CW, Pellegrini CA, et al. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007;21:713–8.

    Article  CAS  PubMed  Google Scholar 

  7. Sweet MP, Nipomnick I, Gasper WJ, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg. 2008;12:159–65.

    Article  PubMed  Google Scholar 

  8. Wang YR, Dempsey DT, Friedenberg FK, et al. Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993–2005: effect of surgery volume on perioperative outcomes. Am J Gastroenterol. 2008;103:2454–64.

    Article  PubMed  Google Scholar 

  9. Patti MG, Fisichella PM. Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia. How I do it. J Gastrointest Surg. 2008;12:764–6.

    Article  PubMed  Google Scholar 

  10. Zaninotto G, Costantini M, Rizzetto C, et al. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248:986–93.

    Article  PubMed  Google Scholar 

  11. Tatum RP, Pellegrini CA. How I do it: laparoscopic Heller myotomy with Toupet fundoplication for achalasia. J Gastrointest Surg. 2009;13:1120–4.

    Article  PubMed  Google Scholar 

  12. Patti MG, Herbella FA. Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: what type. J Gastrointest Surg. 2010;14:1453–8.

    Article  PubMed  Google Scholar 

  13. Roll GR, Ma J, Gasper WJ, et al. Excellent outcomes of laparoscopic esophagomyotomy for achalasia in patients older than 60 years of age. Surg Endosc. 2010;24:2562–6.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Rawlings A, Soper NJ, Oelschlager B, et al. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26:18–26.

    Article  PubMed  Google Scholar 

  15. Pellegrini C, Wetter LA, Patti M, et al. Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg. 1992;216:291–6.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Csendes A, Braghetto I, Burdiles P, et al. Very late results of esophagomyotomy for patients with achalasia. Clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg. 2006;243:196–203.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Zaninotto G, Costantini M, Portale G, et al. Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann Surg. 2002;235:186–92.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Gockel I, Junginger T, Eckardt VF. Persistent and recurrent achalasia after Heller myotomy: analysis of different patterns and long-term results of reoperation. Arch Surg. 2007;142:1093–7.

    Article  PubMed  Google Scholar 

  19. Rossetti G, Brusciano L, Amato G, et al. A total fundoplication is not an obstacle to esophageal emptying after heller myotomy for achalasia: results of a long-term follow up. Ann Surg. 2005;241:614–21.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Zhu ZJ, Chen LQ, Duranceau A. Long-term result of total versus partial fundoplication after esophagomyotomy for primary esophageal motor disorders. World J Surg. 2008;32:401–7.

    Article  PubMed  Google Scholar 

  21. Rebecchi F, Giaccone C, Farinella E, et al. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg. 2008;248:1023–30.

    Article  PubMed  Google Scholar 

  22. Patti MG, Albanese CT, Holcomb 3rd GW, et al. Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children. J Pediatr Surg. 2001;36:1248–51.

    Article  CAS  PubMed  Google Scholar 

  23. Patti MG, Feo CV, Arcerito M, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999;44:2270–6.

    Article  CAS  PubMed  Google Scholar 

  24. Snyder CW, Burton RC, Brown LE, et al. Multiple preoperative endoscopic interventions are associated with worse outcomes after laparoscopic Heller myotomy for achalasia. J Gastrointest Surg. 2009;13:2095–103.

    Article  PubMed  Google Scholar 

  25. Smith CD, Stival A, Howell DL, et al. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg. 2006;243:579–84.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Gossage JA, Devitt PG, Watson DI, et al. Surveillance endoscopy at 5 or more years after cardiomyotomy for achalasia. Ann Surg. 2014;259:464–8.

    Article  PubMed  Google Scholar 

  27. Loviscek MF, Wright AS, Hinojosa MW, et al. Recurrent dysphagia after Heller myotomy: is esophagectomy always the answer? J Am Coll Surg. 2013;216:736–44.

    Article  PubMed  Google Scholar 

  28. Moonka R, Patti MG, Feo CV, et al. Clinical presentation and evaluation of malignant pseudoachalasia. J Gastrointest Surg. 1999;3:456–61.

    Article  CAS  PubMed  Google Scholar 

  29. Patti MG, Diener U, Molena D. Esophageal achalasia: preoperative assessment and postoperative follow-up. J Gastrointest Surg. 2001;5:11–2.

    Article  CAS  PubMed  Google Scholar 

  30. Wang L, Li YM. Recurrent achalasia treated with Heller myotomy: a review of the literature. World J Gastroenterol. 2008;14:7122–6.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Grotenhuis BA, Wijnhoven BP, Myers JC, et al. Reoperation for dysphagia after cardiomyotomy for achalasia. Am J Surg. 2007;194:678–82.

    Article  PubMed  Google Scholar 

  32. Iqbal A, Tierney B, Haider M, et al. Laparoscopic re-operation for failed Heller myotomy. Dis Esophagus. 2006;19:193–9.

    Article  CAS  PubMed  Google Scholar 

  33. Robinson TN, Galvani CA, Dutta SK, et al. Laparoscopic treatment of recurrent dysphagia following transthoracic myotomy for achalasia. J Laparoendosc Adv Surg Tech A. 2003;13:401–3.

    Article  PubMed  Google Scholar 

  34. Pinotti HW, Cecconello I, da Rocha JM, et al. Resection for achalasia of the esophagus. Hepatogastroenterology. 1991;38:470–3.

    CAS  PubMed  Google Scholar 

  35. Devaney EJ, Lannettoni MD, Orringer MB, et al. Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg. 2001;72:854–8.

    Article  CAS  PubMed  Google Scholar 

  36. Inohue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42:265–71.

    Article  Google Scholar 

  37. Swanstrom LL, Kurian A, Dunst CM, et al. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012;256:659–67.

    Article  PubMed  Google Scholar 

  38. Onimaru M, Inohue H, Ikeda H, et al. Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study. J Am Coll Surg. 2013;217:598–605.

    Article  PubMed  Google Scholar 

  39. Vigneswaran Y, Yetasook AK, Zhao JC, et al. Peroral endoscopic myotomy (POEM): feasible as reoperation following Heller myotomy. J Gastrointest Surg. 2014;18:1071–6.

    Article  PubMed  Google Scholar 

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Conflict of Interest

The authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Department of Surgery, Center for Esophageal Diseases, University of Chicago Pritzker School of Medicine, 5841 South Maryland Avenue, Room G-207, Chicago, IL, 60637, USA

    Marco G. Patti MD

  2. Department of Surgical Sciences, University of Torino, Torino, Italy

    Marco E. Allaix MD

Authors
  1. Marco G. Patti MD
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  2. Marco E. Allaix MD
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Corresponding author

Correspondence to Marco G. Patti MD .

Editor information

Editors and Affiliations

  1. Brigham and Women’s Hospital Harvard Medical School, West Roxbury, Massachusetts, USA

    P. Marco Fisichella

  2. Surgery, São Paulo Medical School, São Paulo, São Paulo, Brazil

    Fernando A. M. Herbella

  3. Surgery, University of Chicago, Chicago, Illinois, USA

    Marco G. Patti

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© 2016 Springer International Publishing Switzerland

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Patti, M.G., Allaix, M.E. (2016). Evaluation and Treatment of Patients with Recurrent Dysphagia After Heller Myotomy. In: Fisichella, P., Herbella, F., Patti, M. (eds) Achalasia. Springer, Cham. https://doi.org/10.1007/978-3-319-13569-4_16

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  • DOI: https://doi.org/10.1007/978-3-319-13569-4_16

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13568-7

  • Online ISBN: 978-3-319-13569-4

  • eBook Packages: MedicineMedicine (R0)

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