Achalasia and Respiratory Symptoms: Effect of Laparoscopic Heller Myotomy

Achalasia and Respiratory Symptoms: Effect of Laparoscopic Heller Myotomy

Author Andolfi, Ciro Google Scholar
Kavitt, Robert T. Google Scholar
Herbella, Fernando A. M. Autor UNIFESP Google Scholar
Patti, Marco G. Google Scholar
Abstract Background: Dysphagia and regurgitation are considered typical symptoms of achalasia. However, there is mounting evidence that some achalasia patients may also experience respiratory symptoms such as cough, wheezing, and hoarseness. Aims: The aims of this study were to determine: (1) what percentage of achalasia patients experience respiratory symptoms and (2) the effect of a laparoscopic Heller myotomy and Dor fundoplication on the typical and respiratory symptoms of achalasia. Patients and Methods: Between May 2008 and December 2015, 165 patients with achalasia were referred for treatment to the Center for Esophageal Diseases of the University of Chicago. Patients had preoperatively a barium swallow, endoscopy, and esophageal manometry. All patients underwent a Heller myotomy and Dor fundoplication. Results: Based on the presence of respiratory symptoms, patients were divided into two groups: group A, 98 patients (59%) without respiratory symptoms and group B, 67 patients (41%) with respiratory symptoms. The preoperative Eckardt score was similar in the two groups (6.5 +/- 2.1 versus 6.4 +/- 2.0). The mean esophageal diameter was 27.7 +/- 10.8mm in group A and 42.6 +/- 20.1mm in group B (P<.05). The operation consisted of a myotomy that extended for 5 cm on the esophagus and 2.5 cm onto the gastric wall. At a median postoperative follow-up of 17 months, the Eckardt score improved significantly and similarly in the two groups (0.3 +/- 0.8 versus 0.3 +/- 1.0). Respiratory symptoms improved or resolved in 62 patients (92.5%). Conclusions: The results of this study showed that: (1) respiratory symptoms were present in 41% of patients

(2) patients with respiratory symptoms had a more dilated esophagus

and (3) surgical treatment resolved or improved respiratory symptoms in 92.5% of patients. This study underlines the importance of investigating the presence of respiratory symptoms along with the more common symptoms of achalasia and of early treatment before lung damage occurs.
Language English
Date 2016
Published in Journal Of Laparoendoscopic & Advanced Surgical Techniques. New Rochelle, v. 26, n. 9, p. 675-+, 2016.
ISSN 1092-6429 (Sherpa/Romeo, impact factor)
Publisher Mary Ann Liebert, Inc
Extent 675-+
Origin http://dx.doi.org/10.1089/lap.2016.0246
Access rights Closed access
Type Article
Web of Science ID WOS:000383573200001
URI http://repositorio.unifesp.br/handle/11600/51048

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