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Erschienen in: Surgery Today 8/2013

01.08.2013 | Original Article

Surgical treatment for nonspecific esophageal motility disorders

verfasst von: Takanori Inose, Tatsuya Miyazaki, Shigemasa Suzuki, Naritaka Tanaka, Makoto Sakai, Akihiko Sano, Takehiko Yokobori, Makoto Sohda, Masanobu Nakajima, Minoru Fukuchi, Hiroyuki Kato, Hiroyuki Kuwano

Erschienen in: Surgery Today | Ausgabe 8/2013

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Abstract

Purpose

Nonspecific esophageal motility disorder (NEMD) is a vague category that includes patients with poorly defined contraction abnormalities observed during esophageal manometry. This study investigated the therapeutic effects of the video-assisted thoracoscopic surgery (VATS) approach using long myotomy and fundopexy for NEMD.

Methods

The VATS approach using myotomy and fundopexy was performed for 4 patients of NEMD between 2005 and 2008. A total of 4 patients with NEMD that underwent treatment at our institution were analyzed retrospectively.

Results

The patients included 2 males and 2 females with a median age of 48 years (range 21–74 years). The median duration of NEMD symptoms was 58 months (range 4–108 months). Dysphagia was a primary symptom in all patients. Chest pain was a primary symptom in 3 of 4 patients (75 %). Treatment with medication was attempted before the operation. The median operative time was 344.5 min (range 210–476 min). The median time before starting oral feeding was 2.5 days (range 2–22 days). All patients achieved a significant improvement of their previous condition.

Conclusions

The VATS approach using myotomy and fundopexy for NEMD is a good treatment in cases resistant to medication and balloon dilation.
Literatur
1.
Zurück zum Zitat Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL III, Castell JA, et al. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci. 1987;32:583–92.PubMedCrossRef Richter JE, Wu WC, Johns DN, Blackwell JN, Nelson JL III, Castell JA, et al. Esophageal manometry in 95 healthy adult volunteers. Variability of pressures with age and frequency of “abnormal” contractions. Dig Dis Sci. 1987;32:583–92.PubMedCrossRef
2.
Zurück zum Zitat Achem SR, Crittenden J, Kolts B, Burton L. Long-term clinical and manometric follow-up of patients with nonspecific esophageal motor disorders. Am J Gastroenterol. 1992;87:825–30.PubMed Achem SR, Crittenden J, Kolts B, Burton L. Long-term clinical and manometric follow-up of patients with nonspecific esophageal motor disorders. Am J Gastroenterol. 1992;87:825–30.PubMed
3.
Zurück zum Zitat Herrington JP, Burns TW, Balart LA. Chest pain and dysphagia in patients with prolonged peristaltic contractile duration of the esophagus. Dig Dis Sci. 1984;29:134–40.PubMedCrossRef Herrington JP, Burns TW, Balart LA. Chest pain and dysphagia in patients with prolonged peristaltic contractile duration of the esophagus. Dig Dis Sci. 1984;29:134–40.PubMedCrossRef
4.
Zurück zum Zitat Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology. 1994;107:1865–84.PubMedCrossRef Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology. 1994;107:1865–84.PubMedCrossRef
5.
Zurück zum Zitat Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988;94:73–80.PubMed Kahrilas PJ, Dodds WJ, Hogan WJ. Effect of peristaltic dysfunction on esophageal volume clearance. Gastroenterology. 1988;94:73–80.PubMed
6.
Zurück zum Zitat Benjamin SB, Castell DO. Esophageal causes of chest pain. In: Castell DO, Johnson LF, editors. Esophageal function in health and disease. New York: Elsevier; 1983. p. 85–98. Benjamin SB, Castell DO. Esophageal causes of chest pain. In: Castell DO, Johnson LF, editors. Esophageal function in health and disease. New York: Elsevier; 1983. p. 85–98.
7.
Zurück zum Zitat Castell DO, Richter JE. Non achalasia motility disorders. In: Castell DO, Richter JE, editors. The esophagus. 3rd ed. New York: Lippincott Williams & Wilkins; 1999. p. 118–21. Castell DO, Richter JE. Non achalasia motility disorders. In: Castell DO, Richter JE, editors. The esophagus. 3rd ed. New York: Lippincott Williams & Wilkins; 1999. p. 118–21.
8.
Zurück zum Zitat Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO. Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci. 1997;42:1859–65.PubMedCrossRef Leite LP, Johnston BT, Barrett J, Castell JA, Castell DO. Ineffective esophageal motility (IEM): the primary finding in patients with nonspecific esophageal motility disorder. Dig Dis Sci. 1997;42:1859–65.PubMedCrossRef
9.
Zurück zum Zitat Swamy N. Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites. Gastroenterology. 1977;72:23–7.PubMed Swamy N. Esophageal spasm: clinical and manometric response to nitroglycerine and long acting nitrites. Gastroenterology. 1977;72:23–7.PubMed
10.
Zurück zum Zitat Roberts KE, Duffy AJ, Bell RL. Controversies in the treatment of gastroesophageal reflux and achalasia. World J Gastroenterol. 2006;12:3155–61.PubMed Roberts KE, Duffy AJ, Bell RL. Controversies in the treatment of gastroesophageal reflux and achalasia. World J Gastroenterol. 2006;12:3155–61.PubMed
11.
Zurück zum Zitat Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb. 1991;36:152–4.PubMed Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb. 1991;36:152–4.PubMed
12.
Zurück zum Zitat Bonatti H, Hinder RA, Klocker J, Neuhauser B, Klaus A, Achem SR, de Vault K. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg. 2005;190:874–8.PubMedCrossRef Bonatti H, Hinder RA, Klocker J, Neuhauser B, Klaus A, Achem SR, de Vault K. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg. 2005;190:874–8.PubMedCrossRef
13.
Zurück zum Zitat Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–12. (discussion 412–05).PubMedCrossRef Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240:405–12. (discussion 412–05).PubMedCrossRef
14.
Zurück zum Zitat Torquati A, Lutfi R, Khaitan L, Sharp KW, Richards WO. Heller myotomy vs Heller myotomy plus Dor fundoplication: cost-utility analysis of a randomized trial. Surg Endosc. 2006;20:389–93.PubMedCrossRef Torquati A, Lutfi R, Khaitan L, Sharp KW, Richards WO. Heller myotomy vs Heller myotomy plus Dor fundoplication: cost-utility analysis of a randomized trial. Surg Endosc. 2006;20:389–93.PubMedCrossRef
15.
Zurück zum Zitat Dang Y, Mercer D. Treatment of esophageal achalasia with Heller myotomy: retrospective evaluation of patient satisfaction and disease-specific quality of life. Can J Surg. 2006;49:267–71.PubMed Dang Y, Mercer D. Treatment of esophageal achalasia with Heller myotomy: retrospective evaluation of patient satisfaction and disease-specific quality of life. Can J Surg. 2006;49:267–71.PubMed
16.
Zurück zum Zitat Tello E, de la Garza L, Valdovinos MA, Tielve M, Valdovinos F, Herrera MF. Laparoscopic Heller myotomy for classic achalasia: results of our initial series of 20 patients. Surg Endosc. 2005;19:338–41.PubMedCrossRef Tello E, de la Garza L, Valdovinos MA, Tielve M, Valdovinos F, Herrera MF. Laparoscopic Heller myotomy for classic achalasia: results of our initial series of 20 patients. Surg Endosc. 2005;19:338–41.PubMedCrossRef
17.
Zurück zum Zitat Patti MG, Pellegrini CA, Arcerito M, Tong J, Mulvihill SJ, Way LW. Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders. Arch Surg. 1995;130:609–15. (discussion 615–6).PubMedCrossRef Patti MG, Pellegrini CA, Arcerito M, Tong J, Mulvihill SJ, Way LW. Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders. Arch Surg. 1995;130:609–15. (discussion 615–6).PubMedCrossRef
18.
Zurück zum Zitat Kuwano H, Miyazaki T, Masuda N, Kato H, Kusano M. Long myotomy of the esophagus and gastric cardia with a complete fundic patch procedure for diffuse esophageal spasm. Hepatogastroenterology. 2004;51:1729–31.PubMed Kuwano H, Miyazaki T, Masuda N, Kato H, Kusano M. Long myotomy of the esophagus and gastric cardia with a complete fundic patch procedure for diffuse esophageal spasm. Hepatogastroenterology. 2004;51:1729–31.PubMed
19.
Zurück zum Zitat al-Arfaj AL, Khwaja, Upadhyaya P. Massive hiatal hernia in children. Eur J Surg. 1991;157:465–8.PubMed al-Arfaj AL, Khwaja, Upadhyaya P. Massive hiatal hernia in children. Eur J Surg. 1991;157:465–8.PubMed
20.
Zurück zum Zitat Pearson FG, Cooper JD, Ilves R, Todd TR, Jamieson WR. Massive hiatal hernia with incarceration: a report of 53 cases. Ann Thorac Surg. 1983;35:45–51.PubMedCrossRef Pearson FG, Cooper JD, Ilves R, Todd TR, Jamieson WR. Massive hiatal hernia with incarceration: a report of 53 cases. Ann Thorac Surg. 1983;35:45–51.PubMedCrossRef
21.
Zurück zum Zitat Maziak DE, Todd TR, Pearson FG. Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg. 1998;115:53–60.PubMedCrossRef Maziak DE, Todd TR, Pearson FG. Massive hiatus hernia: evaluation and surgical management. J Thorac Cardiovasc Surg. 1998;115:53–60.PubMedCrossRef
Metadaten
Titel
Surgical treatment for nonspecific esophageal motility disorders
verfasst von
Takanori Inose
Tatsuya Miyazaki
Shigemasa Suzuki
Naritaka Tanaka
Makoto Sakai
Akihiko Sano
Takehiko Yokobori
Makoto Sohda
Masanobu Nakajima
Minoru Fukuchi
Hiroyuki Kato
Hiroyuki Kuwano
Publikationsdatum
01.08.2013
Verlag
Springer Japan
Erschienen in
Surgery Today / Ausgabe 8/2013
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-012-0356-9

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