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Laparoscopic myotomy or pneumatic dilatation for achalasia treatment?

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Kiudelis M., Mickevicius A., Maleckas A., Endzinas Z., Kiudelis G., Jonaitis L., Kupčinskas L.
Open Medicine
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2011
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vol. 6
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issue 5
640-644
2
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Treatment of Esophageal Achalasia - Pneumatic Dilatation Vs Surgical Procedure

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Kawiorski W., Popiela T., Kibil W., Richter P., Kulig J., Popiela T.
Polish Journal of Surgery
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2007
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vol. 79
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issue 11
635-642
EN
Esophageal achalasia, one of the most common motor activity disturbances of the upper gastrointestinal tract, continues to pose a significant diagnostic and therapeutic problem, especially in patients with milder forms of the disease.The aim of the study was to evaluate and compare treatment results (pneumatic dilatation, cardiomy-otomy) in patients with esophageal achalasia, as well as determine the usefulness of intraoperative, continuous manometric monitoring of the corrected segment of the "esophagogastric junction" (evaluation of myotomy).Material and methods. The study group comprised 104 patients, including 71 female and 33 male, treated at the Department during the period between 1997 and 2004. The mean patient age was 43.5 years, ranging between 19 and 75 years. The duration of the disease ranged between 5 months and 22 years.Every patient was subjected to endoscopy, histopathological, radiological and manometric examinations, before treatment. The therapeutic model was based on a two-staged management process. During the initial stage of therapy, patients were subjected to 2-3 pneumatic dilatations. A lack of response to treatment was considered treatment failure and these patients qualified for surgery - Heller's myotomy with antireflux treatment (fundoplication). Cachectic patients requiring immediate surgical intervention were excluded from the study.Results. Following pneumatic dilatation, good or very good results were obtained in 73 (70.2%) of the 104 patients. Procedures were repeated in only 8 (11%) patients, due to the recurrence of dysphagia. The remaining 31 (29.8%) patients underwent surgery with simultaneous intraoperative manometric control of the performed myotomy.Conclusions. Based on the obtained results, one can confirm the significant efficacy of pneumatic dilatation, which is considered the ultimate therapy. In the case of patients in whom we were not able to obtain good clinical results, one observed improved esophagogastric passage, which in turn improved nutritional parameters before planned surgical intervention.Intraoperative esophageal manometry enabled us to accurately evaluate the correctness of myotomy, which seemed to be an indispensable element in the prevention of disease recurrence.
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