Reoperations for esophageal achalasia.

Abstract

PURPOSE:

To define the factors predisposing to recurrence and evaluate the results of reoperations for achalasia.

METHODS:

We reviewed the medical records of ten patients (4 men and 6 women; mean age, 51.5 ± 11.0 years), who underwent reoperations for achalasia between August 1994 and August 2010.

RESULTS:

The primary surgical procedures were Heller-Dor (HD) cardioplasty in nine patients and Heller myotomy in one patient. The factors contributing to failure of the primary operation included inadequate myotomy (n = 2), recurrent adhesion after myotomy (n = 2), reflux esophagitis (n = 2), difficulty in passage caused by tortuosity of the esophagus (n = 2), difficulty in passage through the thoracic esophagus (n = 1), and severe chest pain (n = 1). The reoperations included repeated HD procedures (n = 4), repair of an esophageal hiatal hernia (n = 2), thoracic esophageal myotomy (n = 2), straightening of the lower esophagus with gastropexy (n = 1), and subtotal esophagectomy (n = 1). The success rate of the reoperations for resolving symptoms was 90 % (9 patients).

CONCLUSION:

Selecting surgical procedures based on the causes and conditions of recurrence led to symptomatic improvement and acceptable outcomes.

• Authors: Nobuo Omura, Hideyuki Kashiwagi, Fumiaki Yano, Kazuto Tsuboi, Katsuhiko Yanaga
• Journal: Surgery today (Surg Today) Vol. 42 Issue 11 Pg. 1078-81 (Nov 2012) ISSN: 1436-2813 [Electronic] Japan
• PMID: 22790707 (Publication Type: Comparative Study, Journal Article)

Topics

• Adult
• Cohort Studies
• Esophageal Achalasia (diagnosis, surgery)
• Esophagoscopy (methods)
• Female
• Follow-Up Studies
• Humans
• Incidence
• Laparoscopy (adverse effects, methods)
• Male
• Middle Aged
• Monitoring, Intraoperative (methods)
• Recurrence
• Reoperation (methods)
• Retrospective Studies
• Risk Assessment
• Severity of Illness Index
• Treatment Failure
• Treatment Outcome