1
|
Chadu Junior JB, Oliveira JAD, Faion AG, Zilberstein B. SHORT AND LONG-TERM RESULTS OF LAPAROSCOPIC ESOPHAGOCARDIOMYOTOMY WITH FUNDOPLICATION (HELLER-PINOTTI SURGERY) IN THE TREATMENT OF NON-ADVANCED ACHALASIA (MEGAESOPHAGUS). ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2024; 37:e1803. [PMID: 38896699 PMCID: PMC11182623 DOI: 10.1590/0102-6720202400010e1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/01/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Videolaparoscopic esophagocardiomyotomy with fundoplication has been a widely used technique for the treatment of achalasia. This study analyzes the safety and effectiveness of the technique in the treatment of non-advanced achalasia (megaesophagus) in a Brazilian federal university public hospital. AIMS To evaluate the short- and long-term results of videolaparoscopic treatment of non-advanced megaesophagus in a public university hospital in Brazil, employing the esophagocardiomyotomy technique with fundoplication. METHODS The medical records of 44 patients who underwent surgical treatment for non-advanced achalasia at the Clinical Hospital of Federal University of Uberlândia (UFU-MG), Minas Gerais, from January 2001 to July 2021 were analyzed. The following data were evaluated: gender, age, etiology, radiological classification of Rezende-Alves and Ferreira-Santos, immediate and late complications (mean follow-up of 31.4 months), need or not for conversion to open access, postoperative reflux, performance or not of endoscopic esophageal dilation in the preoperative period, postoperative mortality, frequency of pre and postoperative symptoms (persistent dysphagia, regurgitation, heartburn, vomiting, odynophagia, and weight loss), surgery time, hospital stay, duration of dysphagia, pre and postoperative weight, and Eckardt score. RESULTS Among the analyzed patients, 23 (52.3%) were male, and 21 (47.7%) were female, with a mean age of 50.8 years. No early complications were recorded and there were 27.2% cases of late gastroesophageal reflux. Postoperative weight gain was 81.8% and the success rate of surgery according to the Eckardt score was 84.1%. CONCLUSIONS Esophagocardiomyotomy with fundoplication is an effective and safe technique for the treatment of non-advanced achalasia.
Collapse
Affiliation(s)
- João Bosco Chadu Junior
- Universidade Federal de Uberlândia, Digestive Surgery Unit - Uberlândia (MG), Brazil
- Faculdade São Leopoldo Mandic, Minimally Invasive Surgery, Master of Medical Sciences - Campinas (SP), Brazil
| | | | - Adilson Gomes Faion
- Universidade Federal de Uberlândia, Digestive Surgery Unit - Uberlândia (MG), Brazil
| | - Bruno Zilberstein
- Faculdade São Leopoldo Mandic, Minimally Invasive Surgery, Master of Medical Sciences - Campinas (SP), Brazil
| |
Collapse
|
2
|
Tustumi F, Szachnowicz S, Andreollo NA, Seguro FCBDC, Bianchi ET, Duarte AF, Nasi A, Sallum RAA. MANAGEMENT OF SYMPTOMS RECURRENCE AFTER MYOTOMY FOR ACHALASIA. A PRACTICAL APPROACH. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1780. [PMID: 38088726 PMCID: PMC10712922 DOI: 10.1590/0102-672020230062e1780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Achalasia is an esophageal motility disorder, and myotomy is one of the most used treatment techniques. However, symptom persistence or recurrence occurs in 9 to 20% of cases. AIMS This study aims to provide a practical approach for managing the recurrence or persistence of achalasia symptoms after myotomy. METHODS A critical review was performed to gather evidence for a rational approach for managing the recurrence or persistence of achalasia symptoms after myotomy. RESULTS To properly manage an achalasia patient with significant symptoms after myotomy, such as dysphagia, regurgitation, thoracic pain, and weight loss, it is necessary to classify symptoms, stratify severity, perform appropriate tests, and define a treatment strategy. A systematic differential diagnosis workup is essential to cover the main etiologies of symptoms recurrence or persistence after myotomy. Upper digestive endoscopy and dynamic digital radiography are the main tests that can be applied for investigation. The treatment options include endoscopic dilation, peroral endoscopic myotomy, redo surgery, and esophagectomy, and the decision should be based on the patient's individual characteristics. CONCLUSIONS A good clinical evaluation and the use of proper tests jointly with a rational assessment, are essential for the management of symptoms recurrence or persistence after achalasia myotomy.
Collapse
Affiliation(s)
- Francisco Tustumi
- Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Sérgio Szachnowicz
- Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | | | | | - Edno Tales Bianchi
- Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - André Fonseca Duarte
- Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | - Ary Nasi
- Universidade de São Paulo, Department of Gastroenterology - São Paulo (SP), Brazil
| | | |
Collapse
|
3
|
Dantas RO. Management of Esophageal Dysphagia in Chagas Disease. Dysphagia 2021; 36:517-522. [PMID: 33855597 DOI: 10.1007/s00455-021-10297-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
Chagas disease, caused by the infection of the protozoan parasite Trypanosoma cruzi, has clinical consequences in the heart and digestive tract. The most important changes in the digestive tract occur in the esophagus (megaesophagus) and colon (megacolon). Esophageal dysfunction in Chagas disease results from damage of the esophageal myenteric plexus, with loss of esophageal peristalsis, partial or absent lower esophageal sphincter relaxation, and megaesophagus, which characterizes secondary esophageal achalasia. The treatment options for the disease are similar to those for idiopathic achalasia, consisting of diet and behavior changes, drugs, botulinum toxin, peroral endoscopic myotomy (POEM), pneumatic dilation of the lower esophageal sphincter, laparoscopic Heller myotomy, and esophagectomy. Chagas disease causes a life-threatening cardiopathy, and this should be considered when choosing the most appropriate treatment for the disease. While some options are palliative, for temporary relief of dysphagia (such as drugs, botulinum toxin, and pneumatic dilation), other therapies provide a long-term benefit. In this case, POEM stands out as a modern and successful strategy, with good results in more than 90% of the patients. Esophagectomy is the option in Chagas disease patients with advanced megaesophagus, despite the increased risk of complications. In these cases, peroral endoscopic myotomy may be an option, which needs further evaluation.
Collapse
Affiliation(s)
- Roberto Oliveira Dantas
- Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, Av. Bandeirantes, 3900 - Campus da USP, Ribeirão Preto, SP, Brazil.
| |
Collapse
|
4
|
|
5
|
Câmara ERZ, Madureira FAV, Madureira D, Salomão RM, Iglesias ACRG. LATE EVALUATION OF DYSPHAGIA AFTER HELLER ESOPHAGEAL MYOTOMY WITH DOR FUNDOPLICATION FOR ACHALASIA. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:182-186. [PMID: 29019558 PMCID: PMC5630210 DOI: 10.1590/0102-6720201700030005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 06/06/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND All available treatments for achalasia are palliative and aimed to eliminate the flow resistance caused by a hypertensive lower esophageal sphincter. AIM To analyze the positive and negative prognostic factors in the improvement of dysphagia and to evaluate quality of life in patients undergoing surgery to treat esophageal achalasia by comparing findings before, immediately after, and in long follow-up. METHODS A total of 84 patients who underwent surgery for achalasia between 2001 and 2014 were retrospectively studied. The evaluation protocol with dysphagia scores compared preoperative, immediate (up to three months) postoperative and late (over one year) postoperative scores to estimate quality of life. RESULTS The surgical procedure was Heller-Dor in 100% of cases, with 84 cases performed laparoscopically. The percent reduction in pre- and immediate postoperative lower esophageal sphincter pressurewas 60.35% in the success group and 32.49% in the failure group. Regarding the late postoperative period, the mean percent decrease was 60.15% in the success group and 31.4% in the failure group. The mean overall drop in dysphagia score between the pre- and immediate postoperative periods was 7.33 points, which represents a decrease of 81.17%. CONCLUSIONS Reduction greater than 60% percent in lower esophageal sphincter pressurebetween the pre- and postoperative periods suggests that this metric is a predictor of good prognosis for surgical response. Surgical treatment was able to have a good affect in quality of life and drastically changed dysphagia over time.
Collapse
Affiliation(s)
| | | | - Delta Madureira
- General Surgery Clinic, Fraga Filho University Hospital, Rio de Janeiro, RJ, Brazil
| | - Renato Manganelli Salomão
- General Surgery, Gaffrée and Guinle University Hospital, Federal University of the State of Rio de Janeiro
| | | |
Collapse
|
6
|
Ribeiro JA, Marques MP, Perafán DCM, Lima DND, Rosa SDSRF, Souza ADSD. Análise do deslocamento do bolo alimentar: comparação entre o esôfago saudável e modelo de megaesôfago chagásico. REVISTA CEFAC 2017. [DOI: 10.1590/1982-0216201719311116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: estudar a dinâmica do comportamento do esôfago humano quando afetado por doença de Chagas e propor um controlador orgânico para auxiliar no aperistaltismo do órgão. Métodos: um modelo de massa, mola e amortecedor foi proposto para modelar o deslocamento do bolo alimentar no esôfago durante a ação peristáltica. Foram utilizados parâmetros da literatura para simular o megaesôfago chagásico e o saudável. Resultados: foram analisadas as curvas de velocidade e deslocamento de ambos os modelos e identificou-se as diferenças dinâmicas entre o órgão saudável e um doente. O deslocamento de alimentos em um tipo de Chagas megaesófago II (3 centímetros de dilatação) é apenas 11,84% do deslocamento num esófago saudável. Conclusão: a doença de chagas gera uma velocidade próxima de zero e um alto amortecimento na curva de descida do alimento que devido ao peristaltismo o deslocamento que não pode retornar ao seu estado inicial, o que comprova a retenção do bolo alimentar. Com o sistema de controle orgânico proposto obteve-se uma aproximação das curvas a um comportamento dinâmico próximo do modelo do órgão saudável, minimizando a retenção do alimento.
Collapse
|
7
|
da Silva APC, Boteon YL, Tercioti V, Lopes LR, de Souza Coelho Neto J, Andreollo NA. Megaduodenum associated with gastric strongyloidiasis. Int J Surg Case Rep 2015; 11:71-74. [PMID: 25951613 PMCID: PMC4446660 DOI: 10.1016/j.ijscr.2014.11.066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 11/19/2014] [Accepted: 11/25/2014] [Indexed: 11/09/2022] Open
Abstract
He experienced a long gap without symptoms that were relieved following the surgery performed in his infancy. Nonetheless, no biopsy examination from the duodenum has been done preoperatively. It could explain the delay in reaching the definitive diagnosis. We submitted him to two surgeries. Every patient that comes from an endemic area for Strongyloides stercoralis the hypothesis of strongyloidiasis should be considered and biopsies on stomach and duodenum should be made.
Gastric strongyloidiasis and megaduodenum are rare diseases. Gastrointestinal (GI) strongyloidiasis has many clinical features. One of them is megaduodenum. We describe a case of a 32-years-old man who has come to us from an endemic area for Strongyloides stercoralis. He had had megaduodenum diagnosed in his childhood. We submitted him to two surgeries. He has recovered just after the second surgery, a Roux-en-Y partial gastrectomy. After that, his follow-up was uneventful and the patient has gained 10 kg in weight. Histopathology confirmed gastric strongyloidiasis. In conclusion, if patients arrive from an endemic area of S. stercoralis and if they present GI symptoms or a previous diagnosis of megaduodenum, they must be considered for a histological evaluation for gastric strongyloidiasis.
Collapse
Affiliation(s)
- Amanda Pinter Carvalheiro da Silva
- Digestive Diseases Surgical Unit and Gastrocenter, Department of Surgery, Faculty of Medical Sciences, UNICAMP, SP, Brazil; Department of Surgery, Digestive Diseases Surgical Unit and Gastrocenter, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz, 13083-887 Campinas, SP, Brazil
| | - Yuri Longatto Boteon
- Digestive Diseases Surgical Unit and Gastrocenter, Department of Surgery, Faculty of Medical Sciences, UNICAMP, SP, Brazil; Department of Surgery, Digestive Diseases Surgical Unit and Gastrocenter, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz, 13083-887 Campinas, SP, Brazil
| | - Valdir Tercioti
- Digestive System Diseases Discipline and Gastrocenter, Department of Surgery, Faculty of Medical Sciences, UNICAMP, SP, Brazil; Department of Surgery, Digestive Diseases Surgical Unit and Gastrocenter, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz, 13083-887 Campinas, SP, Brazil
| | - Luiz Roberto Lopes
- Digestive Diseases Surgical Unit and Gastrocenter, Department of Surgery, Faculty of Medical Sciences, UNICAMP, SP, Brazil; Department of Surgery, Digestive Diseases Surgical Unit and Gastrocenter, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz, 13083-887 Campinas, SP, Brazil
| | - João de Souza Coelho Neto
- Digestive Diseases Surgical Unit and Gastrocenter, Department of Surgery, Faculty of Medical Sciences, UNICAMP, SP, Brazil; Department of Surgery, Digestive Diseases Surgical Unit and Gastrocenter, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz, 13083-887 Campinas, SP, Brazil
| | - Nelson Adami Andreollo
- Digestive Diseases Surgical Unit and Gastrocenter, Department of Surgery, Faculty of Medical Sciences, UNICAMP, SP, Brazil; Department of Surgery, Digestive Diseases Surgical Unit and Gastrocenter, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Rua Tessália Vieira de Camargo, 126 - Cidade Universitária Zeferino Vaz, 13083-887 Campinas, SP, Brazil.
| |
Collapse
|
8
|
Affiliation(s)
- Nelson Adami Andreoll
- Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SAo Paulo, Brazil
| | - Luiz Roberto Lope
- Faculdade de Ciencias Medicas, Universidade Estadual de Campinas, Campinas, SAo Paulo, Brazil
| | - Osvaldo Malafai
- Faculdade Evangelica do Parana, Universidade Federal do Parana, Brazil
| |
Collapse
|
9
|
Henry MACDA, Lerco MM. Heller-Pinotti surgery to treat the hipertensive lower esophageal sphincter. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:338-9. [PMID: 24510046 DOI: 10.1590/s0102-67202013000400017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
10
|
A guide for screening, diagnosing, and managing Chagas disease in the United States. JAAPA 2013; 26:16-22. [DOI: 10.1097/01.jaa.0000433834.11889.7c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
11
|
A case of achalasia presented with cardiopulmonary arrest. Case Rep Surg 2013; 2012:794858. [PMID: 23326747 PMCID: PMC3540645 DOI: 10.1155/2012/794858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Accepted: 12/11/2012] [Indexed: 11/17/2022] Open
Abstract
Achalasia is a rare disorder characterised by obstruction of the distal oesophagus and subsequent dilation of the proximal oesophagus. Patients generally complain of gastrointestinal symptoms; however, pulmonary symptoms and complications may also occur. A 35-year-old woman was brought to our emergency service complaining of sudden-onset dyspnea that started 15 minutes earlier during dinner. She suffered a cardiopulmonary arrest due to aspiration 5 minutes after being admitted to the emergency room and was intubated. Thoracic computed tomography examination showed that her oesophagus was filled with undigested food. Heller cardiomyotomy and Dor fundoplication was performed via laparotomy with the diagnosis of primary achalasia, and she was discharged as uneventful on the 5th postoperative day.
Collapse
|