article on myotomy for sigmoid esophagus

[Guest guest]

I happened upon this article:

http://jtcs.ctsnetjournals.org/cgi/content/abstract/128/3/402

A couple of Italian surgeons followed up on patients with sigmoid

E who had Heller myotomy up to 18 years earlier. The esophagus

got narrower after the surgery. Quality of life was improved,

and none of them needed esophagectomy.

I thought it might interest some of you.

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Long-term outcome of Heller mytomy in achalasic sigmoid esophagus

Tommaso Claudio Mineo, MD, Eugenio Pompeo, MD

Division of Thoracic Surgery, Policlinico Tor Vergata

University, Rome, Italy

Received for publication September 28, 2003; revisions received

February 3, 2004; accepted for publication February 5, 2004.

* Address for reprints: Tommaso Claudio Mineo, MD, Cattedra di

Chirurgia Toracica, Policlinico Università Tor Vergata, Via

Oxford 81, 00133 Rome, Italy

mineo@...

OBJECTIVE: We sought to assess the long-term outcome of Heller

myotomy and anterior fundoplication in patients with achalasic

sigmoid esophagus.

METHODS: Fourteen patients with achalasia and sigmoid esophagus

(median age, 42.5 years) operated on by the same surgeon through

a laparotomy (n = 8) or laparoscopic approach (n = 6) between

1985 and 2000 were evaluated. According to a 4-grade

classification (1, no symptoms; 4, persistent symptoms), both

dysphagia and regurgitation had a median score of 4.0. Five

patients complained of respiratory symptoms. Six patients had

undergone previous pneumatic dilation. Preoperative and

postoperative workup included an esophagogram, esophagoscopy,

manometry, and health-related quality-of-life assessment with the

Short-Form 36-item questionnaire.

RESULTS: Median follow-up was 85 months. At 24 months, esophageal

width decreased by 10 mm (P = .003), and the change correlated

inversely with the age of the patients (R = –0.61; P = .02).

Lower esophageal sphincter pressure decreased by 17 mm Hg (P =

..001), and both dysphagia and regurgitation scores decreased to

1.0 (P < .003). Comparison with the results of 37 patients with

earlier-stage achalasia showed no difference in changes of

esophageal width, lower esophageal sphincter pressure, dysphagia

score, and regurgitation score. Quality-of-life Short-Form

36-item questionnaire domains, including general health, social

functioning, and vitality, improved significantly. Overall

results were classified as excellent or good in 10 patients and

as satisfactory and unsatisfactory in 2 patients each. No patient

required esophagectomy or had esophageal carcinoma.

CONCLUSIONS: In this study Heller myotomy proved effective in

improving subjective, objective, and quality-of-life outcome

measures in patients with achalasic sigmoid esophagus and should

be considered as the first-choice treatment for this severe

condition.

[Guest guest]

Thank you very much ,

I personally find that article very reassuring. Up to now I believed that whatever damage was being done over time to the oesophagus with regard to stretching was irreversible, but it sounds as it that is not completely true.

Thanks again , you have made my day very happy.

Love from Ann in England xxxxx>> I happened upon this article:> http://jtcs.ctsnetjournals.org/cgi/content/abstract/128/3/402> > A couple of Italian surgeons followed up on patients with sigmoid> E who had Heller myotomy up to 18 years earlier. The esophagus > got narrower after the surgery. Quality of life was improved, > and none of them needed esophagectomy.> > I thought it might interest some of you.> > -------------------------------------------------------------------> Long-term outcome of Heller mytomy in achalasic sigmoid esophagus> Tommaso Claudio Mineo, MD, Eugenio Pompeo, MD> Division of Thoracic Surgery, Policlinico Tor Vergata> University, Rome, Italy> > Received for publication September 28, 2003; revisions received> February 3, 2004; accepted for publication February 5, 2004.> > * Address for reprints: Tommaso Claudio Mineo, MD, Cattedra di> Chirurgia Toracica, Policlinico Università Tor Vergata, Via> Oxford 81, 00133 Rome, Italy> mineo@...> > OBJECTIVE: We sought to assess the long-term outcome of Heller> myotomy and anterior fundoplication in patients with achalasic> sigmoid esophagus.> > METHODS: Fourteen patients with achalasia and sigmoid esophagus> (median age, 42.5 years) operated on by the same surgeon through> a laparotomy (n = 8) or laparoscopic approach (n = 6) between> 1985 and 2000 were evaluated. According to a 4-grade> classification (1, no symptoms; 4, persistent symptoms), both> dysphagia and regurgitation had a median score of 4.0. Five> patients complained of respiratory symptoms. Six patients had> undergone previous pneumatic dilation. Preoperative and> postoperative workup included an esophagogram, esophagoscopy,> manometry, and health-related quality-of-life assessment with the> Short-Form 36-item questionnaire.> > RESULTS: Median follow-up was 85 months. At 24 months, esophageal> width decreased by 10 mm (P = .003), and the change correlated> inversely with the age of the patients (R = â€"0.61; P = .02).> Lower esophageal sphincter pressure decreased by 17 mm Hg (P => .001), and both dysphagia and regurgitation scores decreased to> 1.0 (P < .003). Comparison with the results of 37 patients with> earlier-stage achalasia showed no difference in changes of> esophageal width, lower esophageal sphincter pressure, dysphagia> score, and regurgitation score. Quality-of-life Short-Form> 36-item questionnaire domains, including general health, social> functioning, and vitality, improved significantly. Overall> results were classified as excellent or good in 10 patients and> as satisfactory and unsatisfactory in 2 patients each. No patient> required esophagectomy or had esophageal carcinoma.> > CONCLUSIONS: In this study Heller myotomy proved effective in> improving subjective, objective, and quality-of-life outcome> measures in patients with achalasic sigmoid esophagus and should> be considered as the first-choice treatment for this severe> condition.>