PMID- 21340730
OWN - NLM
STAT- MEDLINE
DCOM- 20111206
LR  - 20211020
IS  - 2038-131X (Print)
IS  - 2038-131X (Linking)
VI  - 63
IP  - 1
DP  - 2011 Mar
TI  - Laparoscopic Heller myotomy plus Dor fundoplication in 137 achalasic patients: 
      results on symptoms relief and successful outcome predictors.
PG  - 11-5
LID - 10.1007/s13304-011-0050-2 [doi]
AB  - Aim of this study was to review our experience with laparoscopic Heller-Dor (LHD) 
      intervention and identify possible success predictors. LHD is an effective and 
      safe treatment for achalasia. However, open debates are still held on which 
      antireflux procedure should be added and on how long the myotomy on to the 
      stomach should be. A lot of successful outcome predictors have been investigated 
      with sometimes conflicting results. 137 achalasic patients underwent LHD at our 
      institution. Pre-operatively all underwent a complete morphologic and functional 
      work-up. Follow-up visits were scheduled at 1, 3, 6 months and then every year. 
      Median follow-up was 65 months. Pre-operatively dysphagia was present in 100% 
      cases, regurgitation in 84.6% and mean lower esophageal sphincter (LES) resting 
      pressure was 29.1 mmHg. We observed 3 mucosal perforations. Mortality was null. 
      The median of oral food intake resumption was second post-operative day and mean 
      post-operative hospital stay was 3.4 days. Dysphagia was treated with success in 
      94.78% cases and regurgitation in 82.84%. Post-operative mean LES resting 
      pressure was 13.64 mmHg. New-onset heartburn was observed in 10.9% of patients. 
      9.7% of cases required pneumatic dilations and 1.5% a laparoscopic re-do myotomy. 
      An high pre-operative dysphagia score resulted to be the only statistically 
      significant prognostic factor. Sex, age, dysphagia duration and LES resting 
      pressure did not reach statistical significance. LHD is a safe procedure with 
      good results in about 90% of patients even at a long-term follow-up. Predictors 
      of successful outcome are still poorly plain and sometimes conflicting in 
      literature.
FAU - Parise, Paolo
AU  - Parise P
AD  - Regional Referral Center for Diagnosis and Treatment of Diseases of Esophagus, 
      Esophageal Surgery Unit, Gastroenterology Department, "Nuovo s. Chiara" Hospital, 
      Pisa, Italy. p.parise@ao-pisa.toscana.it
FAU - Santi, Stefano
AU  - Santi S
FAU - Solito, Biagio
AU  - Solito B
FAU - Pallabazzer, Giovanni
AU  - Pallabazzer G
FAU - Rossi, Mauro
AU  - Rossi M
LA  - eng
PT  - Journal Article
DEP - 20110222
PL  - Italy
TA  - Updates Surg
JT  - Updates in surgery
JID - 101539818
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Child
MH  - Esophageal Achalasia/*surgery
MH  - Esophagoscopy/*methods
MH  - Female
MH  - Fundoplication/*methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Minimally Invasive Surgical Procedures
MH  - Postoperative Complications
MH  - Prognosis
MH  - Statistics, Nonparametric
MH  - Treatment Outcome
EDAT- 2011/02/23 06:00
MHDA- 2011/12/13 00:00
CRDT- 2011/02/23 06:00
PHST- 2010/10/21 00:00 [received]
PHST- 2011/01/27 00:00 [accepted]
PHST- 2011/02/23 06:00 [entrez]
PHST- 2011/02/23 06:00 [pubmed]
PHST- 2011/12/13 00:00 [medline]
AID - 10.1007/s13304-011-0050-2 [doi]
PST - ppublish
SO  - Updates Surg. 2011 Mar;63(1):11-5. doi: 10.1007/s13304-011-0050-2. Epub 2011 Feb 
      22.