Premium
HP19
RE‐OPERATION FOR DYSPHAGIA AFTER CARDIOMYOTOMY FOR ACHALASIA
Author(s) -
Grotenhuis B. A.,
Wijnhoven B. P. L.,
Myers J. C.,
Jamieson G. G.,
Devitt P. G.,
Watson D. I.
Publication year - 2007
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2007.04122_19.x
Subject(s) - medicine , dysphagia , achalasia , surgery , myotomy , esophagus
Purpose Although laparoscopic cardiomyotomy is considered to be the treatment of choice for achalasia, there is no consensus about how persistent or recurrent dysphagia after myotomy should be treated. In this study we evaluated our experience with re‐operation following previous cardiomyotomy. Methodology From a prospective database, all patients were identified who underwent a re‐cardiomyotomy for persistent or recurrent dysphagia between 1992 and 2006. Results 19 patients (6 female, 13 male) underwent a re‐operation: 7 for persistent and 12 for recurrent dysphagia. The mean time interval between both cardiomyotomies was 81 months. Different operative approaches for reoperations were used, depending on surgeon’s preference and the technique used for the first operation. In 12 patients, the alternative body cavity to that used for the first operation (thoracic versus abdominal) was used for access in the revision operation. This was associated with a shorter operation time (90 vs.128 minutes). An incomplete myotomy or scar tissue were the most common causes of failure identified. Mean hospital stay was 4 days. Mean follow‐up after the revision operation was 3.6 years. 89% of patients had an improvement in symptoms, and the mean satisfaction score (0–10) was 7. Conclusion Re‐operation for persistent or recurrent achalasia achieves a satisfactory outcome in most patients. Using the alternative body cavity to that used in the original procedure facilitates minimal access techniques, and gives easier access to the operative field.