AIM: To present our experience of laparoscopic Heller stretching myotomy followed by His angle reconstruction as surgical approach to esophageal achalasia.METHODS: Thirty-two patients underwent laparoscopic Heller myo...AIM: To present our experience of laparoscopic Heller stretching myotomy followed by His angle reconstruction as surgical approach to esophageal achalasia.METHODS: Thirty-two patients underwent laparoscopic Heller myotomy; an anterior partial fundoplication in 17,and angle of His reconstruction in 15 cases represented the antireflux procedure of choice.RESULTS: There were no morbidity and mortality recorded in both anterior funduplication and angle of His reconstruction groups. No differences were detected in terms of recurrent dysphagia, p.o. reflux or medical therapy.CONCLUSION: To reduce the incidence of recurrent achalasia after laparoscopic Heller myotomy, we believe that His' angle reconstruction is a safe and effective alternative to the anterior fundoplication.展开更多
Background:Gastric electrical stimulators(GESs)have been used to treat refractory gastroparesis in patients who fail initial therapies such as dietary modifications,control of psychological stressors and pharmacologic...Background:Gastric electrical stimulators(GESs)have been used to treat refractory gastroparesis in patients who fail initial therapies such as dietary modifications,control of psychological stressors and pharmacologic treatment.More recently,gastric peroral endoscopic pyloromyotomy(G-POEM)has emerged as a novel endoscopic technique to treat refractory gastroparesis.We present a case series of patients with refractory gastroparesis who failed treatment with an implanted GES that were safely treated with G-POEM performed under fluoroscopy as a salvage therapy.Methods:Cases of G-POEM performed on patients with refractory gastroparesis who failed treatment with a GES were retrospectively reviewed.All G-POEM procedures were performed under fluoroscopic guidance with the GES still in place.Gastroparesis Cardinal Symptoms Index(GCSI)and gastric emptying scintigraphy were assessed before and after the procedure.Patients were followed up for up to 18 months post procedure.Results:Five patients underwent G-POEM after failing treatment with a GES.Under fluoroscopy,the GES and their leads were visualized in different parts of the stomach.One GES lead was observed at the antrum near the myotomy site.All procedures were successfully completed without complications.Patients’GCSI decreased by an average of 62%1 month post procedure.Patients also had notable improvements in gastric emptying 2 months post procedure.Conclusion:In patients with refractory gastroparesis who have failed treatment with a GES,G-POEM can be safe and effective without removing the GES.To visualize the GES and avoid cutting GES leads during myotomy,the procedure should be performed under fluoroscopy.展开更多
文摘AIM: To present our experience of laparoscopic Heller stretching myotomy followed by His angle reconstruction as surgical approach to esophageal achalasia.METHODS: Thirty-two patients underwent laparoscopic Heller myotomy; an anterior partial fundoplication in 17,and angle of His reconstruction in 15 cases represented the antireflux procedure of choice.RESULTS: There were no morbidity and mortality recorded in both anterior funduplication and angle of His reconstruction groups. No differences were detected in terms of recurrent dysphagia, p.o. reflux or medical therapy.CONCLUSION: To reduce the incidence of recurrent achalasia after laparoscopic Heller myotomy, we believe that His' angle reconstruction is a safe and effective alternative to the anterior fundoplication.
文摘Background:Gastric electrical stimulators(GESs)have been used to treat refractory gastroparesis in patients who fail initial therapies such as dietary modifications,control of psychological stressors and pharmacologic treatment.More recently,gastric peroral endoscopic pyloromyotomy(G-POEM)has emerged as a novel endoscopic technique to treat refractory gastroparesis.We present a case series of patients with refractory gastroparesis who failed treatment with an implanted GES that were safely treated with G-POEM performed under fluoroscopy as a salvage therapy.Methods:Cases of G-POEM performed on patients with refractory gastroparesis who failed treatment with a GES were retrospectively reviewed.All G-POEM procedures were performed under fluoroscopic guidance with the GES still in place.Gastroparesis Cardinal Symptoms Index(GCSI)and gastric emptying scintigraphy were assessed before and after the procedure.Patients were followed up for up to 18 months post procedure.Results:Five patients underwent G-POEM after failing treatment with a GES.Under fluoroscopy,the GES and their leads were visualized in different parts of the stomach.One GES lead was observed at the antrum near the myotomy site.All procedures were successfully completed without complications.Patients’GCSI decreased by an average of 62%1 month post procedure.Patients also had notable improvements in gastric emptying 2 months post procedure.Conclusion:In patients with refractory gastroparesis who have failed treatment with a GES,G-POEM can be safe and effective without removing the GES.To visualize the GES and avoid cutting GES leads during myotomy,the procedure should be performed under fluoroscopy.
