Re: Re: Is it usual to have 2nd dilation after myotomy

February 3, 2010

Sandy wrote:

> ... I'd bet 95% the wrap is too tight.

>

Four hundred laparoscopic myotomies for esophageal achalasia: a single

centre experience.

" The operation failed in 10% of patients (39/407) and the 5-year

actuarial probability of being asymptomatic was 87%. Most failures

(25/39, 64%) occurred within 12 months of the operation and can be

considered as technical failures (incomplete myotomy). "

Notice they suggest the main cause is incomplete myotomy in their patients.

[Failure of surgical treatment for achalasia: diagnosis and treatment]

" Above all there is the uncorrect execution of the Heller's myotomy as

for its upward and downward extension or its deepness. An uncorrect

myotomy, in fact, might cause the persistence or relapse of

pre-operative symptoms, such as dysphagia and regurgitation. "

Etiology, diagnosis, and treatment of failures after laparoscopic Heller

myotomy for achalasia.

" CONCLUSIONS: Recurrence of symptoms after myotomy is mainly related to

incomplete myotomy or sclerosis of the distal site of the myotomy. "

Recurrent achalasia treated with Heller myotomy: A review of the literature

" Reasons for failure were incomplete myotomy (33%), myotomy fibrosis

(27%), fundoplication disruption (13%), too tight fundoplication (7%)

and a combination of myotomy fibrosis and incomplete myotomy (20%). "

Notice that " too tight fundoplication " was only 7% and disruption is

something different but more common in their review. Taken together,

" too tight " and " disruption " would only be 20%.

Surgery for achalasia: long-term results in operated achalasic patients.

" The choice of types of surgery between M and M+W was not the cause of

the unsuccessful results whereas the operative strategy and procedures

would have a certain significance on the long-term effect. "

There are probably more like these, but I need to get some sleep. If you

know of a study that says the main cause of failure is a too tight Dor

or Toupet let me know.

notan

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