Impact of minimally invasive surgery on the treatment of esophageal achalasia: A decade of change

Marco G. Patti, Piero M. Fisichella, Silvana Perretta, Carlos A Galvani, Maria Gorodner V, Thomas Robinson, Lawrence W. Way, Bruce V. MacFadyen

Research output: Contribution to journalArticle

142 Citations (Scopus)

Abstract

BACKGROUND: Twenty years ago an average of 1.5 Heller myotomies were performed per year in our hospital, mostly for patients whose dysphagia did not improve following balloon dilatation or whose esophagus had been perforated during a balloon dilatation. Ten years ago we started using minimally invasive surgery to treat this disease. STUDY DESIGN: This study measures the impact of minimally invasive surgery with regard to the following: the number of patients referred for treatment; the number of patients who came to surgery without previous treatment; and the results of surgical treatment. Between 1991 and 2001, 149 patients had minimally invasive surgery for achalasia: 25 patients (17%) had thoracoscopic Heller myotomy and 124 (84%) had laparoscopic Heller myotomy and Dor fundoplication. Of the 149 patients, 79 patients (53%) had previous treatment (56 patients [71%], balloon dilatation; 7 patients [9%], botulinum toxin injection; 16 patients [20%], both) and 70 patients (43%) had none of these treatments. Mean postoperative followup was 59 ± 36 months. Patients were divided into two groups: group A, operated on between 1991 and 1995; and group B, operated on between 1996 and 2001. RESULTS: In the past decade, the number of patients referred for surgery has increased substantially - group A, 48; group B, 101; an increasing proportion of patients were referred for surgery without previous treatment - group A, 38%; group B, 51%; and the outcomes of the operation progressively improved - group A, 87%; group B, 95%. CONCLUSIONS: These data show that the high success rate of laparoscopic Heller myotomy for achalasia has brought a shift in practice; surgery has become the preferred treatment of most gastroenterologists and other referring physicians. This has followed documentation that laparoscopic treatment outperforms balloon dilatation and botulinum toxin injection.

Original languageEnglish (US)
Pages (from-to)698-705
Number of pages8
JournalJournal of the American College of Surgeons
Volume196
Issue number5
DOIs
StatePublished - May 1 2003
Externally publishedYes

Fingerprint

Esophageal Achalasia
Minimally Invasive Surgical Procedures
Therapeutics
Dilatation
Botulinum Toxins
Fundoplication
Injections
Deglutition Disorders
Documentation
Esophagus

ASJC Scopus subject areas

  • Surgery

Cite this

Impact of minimally invasive surgery on the treatment of esophageal achalasia : A decade of change. / Patti, Marco G.; Fisichella, Piero M.; Perretta, Silvana; Galvani, Carlos A; Gorodner V, Maria; Robinson, Thomas; Way, Lawrence W.; MacFadyen, Bruce V.

In: Journal of the American College of Surgeons, Vol. 196, No. 5, 01.05.2003, p. 698-705.

Research output: Contribution to journalArticle

Patti, MG, Fisichella, PM, Perretta, S, Galvani, CA, Gorodner V, M, Robinson, T, Way, LW & MacFadyen, BV 2003, 'Impact of minimally invasive surgery on the treatment of esophageal achalasia: A decade of change', Journal of the American College of Surgeons, vol. 196, no. 5, pp. 698-705. https://doi.org/10.1016/S1072-7515(02)01837-9
Patti, Marco G. ; Fisichella, Piero M. ; Perretta, Silvana ; Galvani, Carlos A ; Gorodner V, Maria ; Robinson, Thomas ; Way, Lawrence W. ; MacFadyen, Bruce V. / Impact of minimally invasive surgery on the treatment of esophageal achalasia : A decade of change. In: Journal of the American College of Surgeons. 2003 ; Vol. 196, No. 5. pp. 698-705.
@article{4953993d66aa48629f9a0c003130fbd9,
title = "Impact of minimally invasive surgery on the treatment of esophageal achalasia: A decade of change",
abstract = "BACKGROUND: Twenty years ago an average of 1.5 Heller myotomies were performed per year in our hospital, mostly for patients whose dysphagia did not improve following balloon dilatation or whose esophagus had been perforated during a balloon dilatation. Ten years ago we started using minimally invasive surgery to treat this disease. STUDY DESIGN: This study measures the impact of minimally invasive surgery with regard to the following: the number of patients referred for treatment; the number of patients who came to surgery without previous treatment; and the results of surgical treatment. Between 1991 and 2001, 149 patients had minimally invasive surgery for achalasia: 25 patients (17{\%}) had thoracoscopic Heller myotomy and 124 (84{\%}) had laparoscopic Heller myotomy and Dor fundoplication. Of the 149 patients, 79 patients (53{\%}) had previous treatment (56 patients [71{\%}], balloon dilatation; 7 patients [9{\%}], botulinum toxin injection; 16 patients [20{\%}], both) and 70 patients (43{\%}) had none of these treatments. Mean postoperative followup was 59 ± 36 months. Patients were divided into two groups: group A, operated on between 1991 and 1995; and group B, operated on between 1996 and 2001. RESULTS: In the past decade, the number of patients referred for surgery has increased substantially - group A, 48; group B, 101; an increasing proportion of patients were referred for surgery without previous treatment - group A, 38{\%}; group B, 51{\%}; and the outcomes of the operation progressively improved - group A, 87{\%}; group B, 95{\%}. CONCLUSIONS: These data show that the high success rate of laparoscopic Heller myotomy for achalasia has brought a shift in practice; surgery has become the preferred treatment of most gastroenterologists and other referring physicians. This has followed documentation that laparoscopic treatment outperforms balloon dilatation and botulinum toxin injection.",
author = "Patti, {Marco G.} and Fisichella, {Piero M.} and Silvana Perretta and Galvani, {Carlos A} and {Gorodner V}, Maria and Thomas Robinson and Way, {Lawrence W.} and MacFadyen, {Bruce V.}",
year = "2003",
month = "5",
day = "1",
doi = "10.1016/S1072-7515(02)01837-9",
language = "English (US)",
volume = "196",
pages = "698--705",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Impact of minimally invasive surgery on the treatment of esophageal achalasia

T2 - A decade of change

AU - Patti, Marco G.

AU - Fisichella, Piero M.

AU - Perretta, Silvana

AU - Galvani, Carlos A

AU - Gorodner V, Maria

AU - Robinson, Thomas

AU - Way, Lawrence W.

AU - MacFadyen, Bruce V.

PY - 2003/5/1

Y1 - 2003/5/1

N2 - BACKGROUND: Twenty years ago an average of 1.5 Heller myotomies were performed per year in our hospital, mostly for patients whose dysphagia did not improve following balloon dilatation or whose esophagus had been perforated during a balloon dilatation. Ten years ago we started using minimally invasive surgery to treat this disease. STUDY DESIGN: This study measures the impact of minimally invasive surgery with regard to the following: the number of patients referred for treatment; the number of patients who came to surgery without previous treatment; and the results of surgical treatment. Between 1991 and 2001, 149 patients had minimally invasive surgery for achalasia: 25 patients (17%) had thoracoscopic Heller myotomy and 124 (84%) had laparoscopic Heller myotomy and Dor fundoplication. Of the 149 patients, 79 patients (53%) had previous treatment (56 patients [71%], balloon dilatation; 7 patients [9%], botulinum toxin injection; 16 patients [20%], both) and 70 patients (43%) had none of these treatments. Mean postoperative followup was 59 ± 36 months. Patients were divided into two groups: group A, operated on between 1991 and 1995; and group B, operated on between 1996 and 2001. RESULTS: In the past decade, the number of patients referred for surgery has increased substantially - group A, 48; group B, 101; an increasing proportion of patients were referred for surgery without previous treatment - group A, 38%; group B, 51%; and the outcomes of the operation progressively improved - group A, 87%; group B, 95%. CONCLUSIONS: These data show that the high success rate of laparoscopic Heller myotomy for achalasia has brought a shift in practice; surgery has become the preferred treatment of most gastroenterologists and other referring physicians. This has followed documentation that laparoscopic treatment outperforms balloon dilatation and botulinum toxin injection.

AB - BACKGROUND: Twenty years ago an average of 1.5 Heller myotomies were performed per year in our hospital, mostly for patients whose dysphagia did not improve following balloon dilatation or whose esophagus had been perforated during a balloon dilatation. Ten years ago we started using minimally invasive surgery to treat this disease. STUDY DESIGN: This study measures the impact of minimally invasive surgery with regard to the following: the number of patients referred for treatment; the number of patients who came to surgery without previous treatment; and the results of surgical treatment. Between 1991 and 2001, 149 patients had minimally invasive surgery for achalasia: 25 patients (17%) had thoracoscopic Heller myotomy and 124 (84%) had laparoscopic Heller myotomy and Dor fundoplication. Of the 149 patients, 79 patients (53%) had previous treatment (56 patients [71%], balloon dilatation; 7 patients [9%], botulinum toxin injection; 16 patients [20%], both) and 70 patients (43%) had none of these treatments. Mean postoperative followup was 59 ± 36 months. Patients were divided into two groups: group A, operated on between 1991 and 1995; and group B, operated on between 1996 and 2001. RESULTS: In the past decade, the number of patients referred for surgery has increased substantially - group A, 48; group B, 101; an increasing proportion of patients were referred for surgery without previous treatment - group A, 38%; group B, 51%; and the outcomes of the operation progressively improved - group A, 87%; group B, 95%. CONCLUSIONS: These data show that the high success rate of laparoscopic Heller myotomy for achalasia has brought a shift in practice; surgery has become the preferred treatment of most gastroenterologists and other referring physicians. This has followed documentation that laparoscopic treatment outperforms balloon dilatation and botulinum toxin injection.

UR - http://www.scopus.com/inward/record.url?scp=0037989674&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037989674&partnerID=8YFLogxK

U2 - 10.1016/S1072-7515(02)01837-9

DO - 10.1016/S1072-7515(02)01837-9

M3 - Article

C2 - 12742198

AN - SCOPUS:0037989674

VL - 196

SP - 698

EP - 705

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 5

ER -