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SAGES guidelines for the surgical treatment of esophageal achalasia

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References

  1. Guyatt GH, Oxman AD, Kunz R, Falck-Ytter Y, Vist GE, Liberati A, Schunemann HJ (2008) Going from evidence to recommendations. BMJ 336:1049–1051

    Article  PubMed  Google Scholar 

  2. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, Schunemann HJ (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336:924–926

    Article  PubMed  Google Scholar 

  3. Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstatter M, Lin F, Ciovica R (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249:45–57

    Article  PubMed  Google Scholar 

  4. Goldblum JR, Rice TW, Richter JE (1996) Histopathologic features in esophagomyotomy specimens from patients with achalasia. Gastroenterology 111:648–654

    Article  PubMed  CAS  Google Scholar 

  5. Woltman TA, Pellegrini CA, Oelschlager BK (2005) Achalasia. Surg Clin North Am 85:483–493

    Article  PubMed  Google Scholar 

  6. Vaezi MF, Richter JE (1999) Diagnosis and management of achalasia. American College of Gastroenterology Practice Parameter Committee. Am J Gastroenterol 94:3406–3412

    Article  PubMed  CAS  Google Scholar 

  7. Eckardt AJ, Eckardt VF (2009) Current clinical approach to achalasia. World J Gastroenterol 15:3969–3975

    Article  PubMed  Google Scholar 

  8. Wen ZH, Gardener E, Wang YP (2004) Nitrates for achalasia. Cochrane Database Syst Rev CD002299

  9. Bassotti G, Annese V (1999) Review article: pharmacological options in achalasia. Aliment Pharmacol Ther 13:1391–1396

    Article  PubMed  CAS  Google Scholar 

  10. Short TP, Thomas E (1992) An overview of the role of calcium antagonists in the treatment of achalasia and diffuse oesophageal spasm. Drugs 43:177–184

    Article  PubMed  CAS  Google Scholar 

  11. Annese V, Bassotti G (2006) Non-surgical treatment of esophageal achalasia. World J Gastroenterol 12:5763–5766

    PubMed  Google Scholar 

  12. Storr M, Born P, Frimberger E, Weigert N, Rosch T, Meining A, Classen M, Allescher HD (2002) Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment. BMC Gastroenterol 2:19

    Article  PubMed  CAS  Google Scholar 

  13. Martinek J, Siroky M, Plottova Z, Bures J, Hep A, Spicak J (2003) Treatment of patients with achalasia with botulinum toxin: a multicenter prospective cohort study. Dis Esophagus 16:204–209

    Article  PubMed  CAS  Google Scholar 

  14. Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN (1996) Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology 110:1410–1415

    Article  PubMed  CAS  Google Scholar 

  15. Allescher HD, Storr M, Seige M, Gonzales-Donoso R, Ott R, Born P, Frimberger E, Weigert N, Stier A, Kurjak M, Rosch T, Classen M (2001) Treatment of achalasia: botulinum toxin injection vs. pneumatic balloon dilation. A prospective study with long-term follow-Up. Endoscopy 33:1007–1017

    Article  PubMed  CAS  Google Scholar 

  16. Annese V, Bassotti G, Coccia G, Dinelli M, D’Onofrio V, Gatto G, Leandro G, Repici A, Testoni PA, Andriulli A (2000) A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 46:597–600

    Article  PubMed  CAS  Google Scholar 

  17. Bassotti G, D’Onofrio V, Battaglia E, Fiorella S, Dughera L, Iaquinto G, Mazzocchi A, Morelli A, Annese V (2006) Treatment with botulinum toxin of octo-nonagerians with oesophageal achalasia: a two-year follow-up study. Aliment Pharmacol Ther 23:1615–1619

    Article  PubMed  CAS  Google Scholar 

  18. Hashemi N, Banwait KS, DiMarino AJ, Cohen S (2005) Manometric evaluation of achalasia in the elderly. Aliment Pharmacol Ther 21:431–434

    Article  PubMed  CAS  Google Scholar 

  19. Neubrand M, Scheurlen C, Schepke M, Sauerbruch T (2002) Long-term results and prognostic factors in the treatment of achalasia with botulinum toxin. Endoscopy 34:519–523

    Article  PubMed  CAS  Google Scholar 

  20. Kolbasnik J, Waterfall WE, Fachnie B, Chen Y, Tougas G (1999) Long-term efficacy of Botulinum toxin in classical achalasia: a prospective study. Am J Gastroenterol 94:3434–3439

    Article  PubMed  CAS  Google Scholar 

  21. Mac Iver R, Liptay M, Johnson Y (2007) A case of mediastinitis following botulinum toxin type A treatment for achalasia. Nat Clin Pract Gastroenterol Hepatol 4:579–582

    PubMed  Google Scholar 

  22. Malnick SD, Metchnik L, Somin M, Bergman N, Attali M (2000) Fatal heart block following treatment with botulinum toxin for achalasia. Am J Gastroenterol 95:3333–3334

    Article  PubMed  CAS  Google Scholar 

  23. Leyden JE, Moss AC, MacMathuna P (2006) Endoscopic pneumatic dilation versus botulinum toxin injection in the management of primary achalasia. Cochrane Database Syst Rev CD005046

  24. Wang L, Li YM, Li L, Yu CH (2008) A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia. World J Gastroenterol 14:5900–5906

    Article  PubMed  Google Scholar 

  25. Annese V, Bassotti G, Coccia G, D’Onofrio V, Gatto G, Repici A, Andriulli A (1999) Comparison of two different formulations of botulinum toxin A for the treatment of oesophageal achalasia. The Gismad Achalasia Study Group. Aliment Pharmacol Ther 13:1347–1350

    Article  PubMed  CAS  Google Scholar 

  26. Pohl D, Tutuian R (2007) Achalasia: an overview of diagnosis and treatment. J Gastrointest Liver Dis 16:297–303

    Google Scholar 

  27. Kadakia SC, Wong RK (2001) Pneumatic balloon dilation for esophageal achalasia. Gastrointest Endosc Clin N Am 11:325–346 vii

    PubMed  CAS  Google Scholar 

  28. Chuah SK, Hu TH, Wu KL, Kuo CM, Fong TV, Lee CM, Changchien CS (2008) Endoscope-guided pneumatic dilatation of esophageal achalasia without fluoroscopy is another safe and effective treatment option: a report of Taiwan. Surg Laparosc Endosc Percutan Tech 18:8–12

    Article  PubMed  Google Scholar 

  29. Eckardt VF, Gockel I, Bernhard G (2004) Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 53:629–633

    Article  PubMed  CAS  Google Scholar 

  30. Katsinelos P, Kountouras J, Paroutoglou G, Beltsis A, Zavos C, Papaziogas B, Mimidis K (2005) Long-term results of pneumatic dilation for achalasia: a 15 years’ experience. World J Gastroenterol 11:5701–5705

    PubMed  Google Scholar 

  31. West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxstaens GE (2002) Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol 97:1346–1351

    Article  PubMed  CAS  Google Scholar 

  32. Zerbib F, Thetiot V, Richy F, Benajah DA, Message L, Lamouliatte H (2006) Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia. Am J Gastroenterol 101:692–697

    Article  PubMed  Google Scholar 

  33. Gockel I, Junginger T, Bernhard G, Eckardt VF (2004) Heller myotomy for failed pneumatic dilation in achalasia: How effective is it? Ann Surg 239:371–377

    Article  PubMed  Google Scholar 

  34. Farhoomand K, Connor JT, Richter JE, Achkar E, Vaezi MF (2004) Predictors of outcome of pneumatic dilation in achalasia. Clin Gastroenterol Hepatol 2:389–394

    Article  PubMed  Google Scholar 

  35. Dagli U, Kuran S, Savas N, Ozin Y, Alkim C, Atalay F, Sahin B (2009) Factors predicting outcome of balloon dilatation in achalasia. Dig Dis Sci 54:1237–1242

    Article  PubMed  Google Scholar 

  36. Leeuwenburgh I, Van Dekken H, Scholten P, Hansen BE, Haringsma J, Siersema PD, Kuipers EJ (2006) Oesophagitis is common in patients with achalasia after pneumatic dilatation. Aliment Pharmacol Ther 23:1197–1203

    Article  PubMed  CAS  Google Scholar 

  37. Vela MF, Richter JE, Khandwala F, Blackstone EH, Wachsberger D, Baker ME, Rice TW (2006) The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol 4:580–587

    Article  PubMed  Google Scholar 

  38. Mikaeli J, Bishehsari F, Montazeri G, Mahdavinia M, Yaghoobi M, Darvish-Moghadam S, Farrokhi F, Shirani S, Estakhri A, Malekzadeh R (2006) Injection of botulinum toxin before pneumatic dilatation in achalasia treatment: a randomized-controlled trial. Aliment Pharmacol Ther 24:983–989

    Article  PubMed  CAS  Google Scholar 

  39. Mukherjee S, Kaplan DS, Parasher G, Sipple MS (2000) Expandable metal stents in achalasia—Is there a role? Am J Gastroenterol 95:2185–2188

    PubMed  CAS  Google Scholar 

  40. Cheng YS, Li MH, Chen WX, Chen NW, Zhuang QX, Shang KZ (2003) Selection and evaluation of three interventional procedures for achalasia based on long-term follow-up. World J Gastroenterol 9:2370–2373

    PubMed  Google Scholar 

  41. Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271

    Article  PubMed  CAS  Google Scholar 

  42. Kuster GG (1998) Local epinephrine facilitates laparoscopic Heller myotomy. Surg Endosc 12:79–81

    Article  PubMed  CAS  Google Scholar 

  43. Endo S, Nakajima K, Nishikawa K, Takahashi T, Souma Y, Taniguchi E, Ito T, Nishida T (2009) Laparoscopic Heller-Dor surgery for esophageal achalasia: impact of intraoperative real-time manometric feedback on postoperative outcomes. Dig Surg 26:342–348

    Article  PubMed  Google Scholar 

  44. Jeansonne LO, White BC, Pilger KE, Shane MD, Zagorski S, Davis SS, Hunter JG, Lin E, Smith CD (2007) Ten-year follow-up of laparoscopic Heller myotomy for achalasia shows durability. Surg Endosc 21:1498–1502

    Article  PubMed  Google Scholar 

  45. Csendes A, Braghetto I, Henriquez A, Cortes C (1989) Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut 30:299–304

    Article  PubMed  CAS  Google Scholar 

  46. Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henriquez A (2006) Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg 243:196–203

    Article  PubMed  Google Scholar 

  47. Tsiaoussis J, Athanasakis E, Pechlivanides G, Tzortzinis A, Gouvas N, Mantides A, Xynos E (2007) Long-term functional results after laparoscopic surgery for esophageal achalasia. Am J Surg 193:26–31

    Article  PubMed  Google Scholar 

  48. Rakita S, Bloomston M, Villadolid D, Thometz D, Boe B, Rosemurgy A (2005) Age affects presenting symptoms of achalasia and outcomes after myotomy. Am Surg 71:424–429

    PubMed  Google Scholar 

  49. Bessell JR, Lally CJ, Schloithe A, Jamieson GG, Devitt PG, Watson DI (2006) Laparoscopic cardiomyotomy for achalasia: long-term outcomes. ANZ J Surg 76:558–562

    Article  PubMed  Google Scholar 

  50. Wang L, Li YM, Li L (2009) Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci 54:2303–2311

    Article  PubMed  CAS  Google Scholar 

  51. Ferulano GP, Dilillo S, D’Ambra M, Lionetti R, Saviano C, Fico D (2005) Oesophageal achalasia in elderly people: results of the laparoscopic Heller-Dor myotomy. Acta Biomed 76(Suppl 1):37–41

    PubMed  Google Scholar 

  52. Yamamura MS, Gilster JC, Myers BS, Deveney CW, Sheppard BC (2000) Laparoscopic Heller myotomy and anterior fundoplication for achalasia results in a high degree of patient satisfaction. Arch Surg 135:902–906

    Article  PubMed  CAS  Google Scholar 

  53. Ben-Meir A, Urbach DR, Khajanchee YS, Hansen PD, Swanstrom LL (2001) Quality of life before and after laparoscopic Heller myotomy for achalasia. Am J Surg 181:471–474

    Article  PubMed  CAS  Google Scholar 

  54. Mineo TC, Ambrogi V (2004) Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon’s experience. Eur J Cardiothorac Surg 25:1089–1096

    Article  PubMed  Google Scholar 

  55. Eckardt VF, Stauf B, Bernhard G (1999) Chest pain in achalasia: patient characteristics and clinical course. Gastroenterology 116:1300–1304

    Article  PubMed  CAS  Google Scholar 

  56. Smith CD, Stival A, Howell DL, Swafford V (2006) Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg 243:579–584; discussion 584–576

    Article  PubMed  Google Scholar 

  57. Deb S, Deschamps C, Allen MS, Nichols FC 3rd, Cassivi SD, Crownhart BS, Pairolero PC (2005) Laparoscopic esophageal myotomy for achalasia: factors affecting functional results. Ann Thorac Surg 80:1191–1194; discussion 1194–1195

    Article  PubMed  Google Scholar 

  58. Beckingham IJ, Callanan M, Louw JA, Bornman PC (1999) Laparoscopic cardiomyotomy for achalasia after failed balloon dilatation. Surg Endosc 13:493–496

    Article  PubMed  CAS  Google Scholar 

  59. Morino M, Rebecchi F, Festa V, Garrone C (1997) Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy. Surg Endosc 11:359–361

    Article  PubMed  CAS  Google Scholar 

  60. Vantrappen G, Hellemans J, Deloof W, Valembois P, Vandenbroucke J (1971) Treatment of achalasia with pneumatic dilatations. Gut 12:268–275

    Article  PubMed  CAS  Google Scholar 

  61. Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, Gantert W, Way LW (1999) Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci 44:2270–2276

    Article  PubMed  CAS  Google Scholar 

  62. Rosemurgy A, Villadolid D, Thometz D, Kalipersad C, Rakita S, Albrink M, Johnson M, Boyce W (2005) Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after Botox or dilation. Ann Surg 241:725–733; discussion 733–725

    Article  PubMed  Google Scholar 

  63. Horgan S, Pellegrini CA (1999) Botulinum toxin injections for achalasia symptoms. Am J Gastroenterol 94:300–301

    Article  PubMed  CAS  Google Scholar 

  64. Fishman VM, Parkman HP, Schiano TD, Hills C, Dabezies MA, Cohen S, Fisher RS, Miller LS (1996) Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol 91:1724–1730

    PubMed  CAS  Google Scholar 

  65. Horgan S, Hudda K, Eubanks T, McAllister J, Pellegrini CA (1999) Does botulinum toxin injection make esophagomyotomy a more difficult operation? Surg Endosc 13:576–579

    Article  PubMed  CAS  Google Scholar 

  66. Bonavina L, Incarbone R, Antoniazzi L, Reitano M, Peracchia A (1999) Previous endoscopic treatment does not affect complication rate and outcome of laparoscopic Heller myotomy and anterior fundoplication for oesophageal achalasia. Ital J Gastroenterol Hepatol 31:827–830

    PubMed  CAS  Google Scholar 

  67. Peracchia A, Bonavina L (2000) Achalasia: dilation, injection or surgery? Can J Gastroenterol 14:441–443

    PubMed  CAS  Google Scholar 

  68. Kostic S, Kjellin A, Ruth M, Lonroth H, Johnsson E, Andersson M, Lundell L (2007) Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg 31:470–478

    Article  PubMed  CAS  Google Scholar 

  69. Lopushinsky SR, Urbach DR (2006) Pneumatic dilatation and surgical myotomy for achalasia. JAMA 296:2227–2233

    Article  PubMed  CAS  Google Scholar 

  70. Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, Gatto G, D’Onofrio V, Benini L, Contini S, Molena D, Battaglia G, Tardio B, Andriulli A, Ancona E (2004) Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg 239:364–370

    Article  PubMed  Google Scholar 

  71. Urbach DR, Hansen PD, Khajanchee YS, Swanstrom LL (2001) A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection. J Gastrointest Surg 5:192–205

    Article  PubMed  CAS  Google Scholar 

  72. Douard R, Gaudric M, Chaussade S, Couturier D, Houssin D, Dousset B (2004) Functional results after laparoscopic Heller myotomy for achalasia: a comparative study to open surgery. Surgery 136:16–24

    Article  PubMed  Google Scholar 

  73. Crema E, Benelli AG, Silva AV, Martins AJ, Pastore R, Kujavao GH, Silva AA, Santana JR (2005) Assessment of pulmonary function in patients before and after laparoscopic and open esophagogastric surgery. Surg Endosc 19:133–136

    Article  PubMed  CAS  Google Scholar 

  74. Collard JM, Romagnoli R, Lengele B, Salizzoni M, Kestens PJ (1996) Heller-Dor procedure for achalasia: from conventional to video-endoscopic surgery. Acta Chir Belg 96:62–65

    PubMed  CAS  Google Scholar 

  75. Dempsey DT, Kalan MM, Gerson RS, Parkman HP, Maier WP (1999) Comparison of outcomes following open and laparoscopic esophagomyotomy for achalasia. Surg Endosc 13:747–750

    Article  PubMed  CAS  Google Scholar 

  76. Katilius M, Velanovich V (2001) Heller myotomy for achalasia: quality of life comparison of laparoscopic and open approaches. JSLS 5:227–231

    PubMed  CAS  Google Scholar 

  77. Torquati A, Richards WO, Holzman MD, Sharp KW (2006) Laparoscopic myotomy for achalasia: predictors of successful outcome after 200 cases. Ann Surg 243:587–591; discussion 591–583

    Article  PubMed  Google Scholar 

  78. Horgan S, Galvani C, Gorodner MV, Omelanczuck P, Elli F, Moser F, Durand L, Caracoche M, Nefa J, Bustos S, Donahue P, Ferraina P (2005) Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study. J Gastrointest Surg 9:1020–1029; discussion 1029–1030

    Article  PubMed  Google Scholar 

  79. Huffmanm LC, Pandalai PK, Boulton BJ, James L, Starnes SL, Reed MF, Howington JA, Nussbaum MS (2007) Robotic Heller myotomy: a safe operation with higher postoperative quality-of-life indices. Surgery 142:613–618; discussion 618–620

    Article  PubMed  CAS  Google Scholar 

  80. Maeso S, Reza M, Mayol JA, Blasco JA, Guerra M, Andradas E, Plana MN (2010) Efficacy of the Da Vinci surgical system in abdominal surgery compared with that of laparoscopy: a systematic review and meta-analysis. Ann Surg 252:254–262

    Article  PubMed  Google Scholar 

  81. Wang PC, Sharp KW, Holzman MD, Clements RH, Holcomb GW, Richards WO (1998) The outcome of laparoscopic Heller myotomy without antireflux procedure in patients with achalasia. Am Surg 64:515–520; discussion 521

    PubMed  CAS  Google Scholar 

  82. Dempsey DT, Delano M, Bradley K, Kolff J, Fisher C, Caroline D, Gaughan J, Meilahn JE, Daly JM (2004) Laparoscopic esophagomyotomy for achalasia: does anterior hemifundoplication affect clinical outcome? Ann Surg 239:779–785; discussion 785–777

    Article  PubMed  Google Scholar 

  83. Sharp KW, Khaitan L, Scholz S, Holzman MD, Richards WO (2002) 100 consecutive minimally invasive Heller myotomies: lessons learned. Ann Surg 235:631–638; discussion 638–639

    Article  PubMed  Google Scholar 

  84. Bloomston M, Rosemurgy AS (2002) Selective application of fundoplication during laparoscopic Heller myotomy ensures favorable outcomes. Surg Laparosc Endosc Percutan Tech 12:309–315

    Article  PubMed  Google Scholar 

  85. Diamantis T, Pikoulis E, Felekouras E, Tsigris C, Arvelakis A, Karavokyros I, Bastounis E (2006) Laparoscopic esophagomyotomy for achalasia without a complementary antireflux procedure. J Laparoendosc Adv Surg Tech A 16:345–349

    Article  PubMed  Google Scholar 

  86. Kjellin AP, Granqvist S, Ramel S, Thor KB (1999) Laparoscopic myotomy without fundoplication in patients with achalasia. Eur J Surg 165:1162–1166

    Article  PubMed  CAS  Google Scholar 

  87. Burpee SE, Mamazza J, Schlachta CM, Bendavid Y, Klein L, Moloo H, Poulin EC (2005) Objective analysis of gastroesophageal reflux after laparoscopic Heller myotomy: an anti-reflux procedure is required. Surg Endosc 19:9–14

    Article  PubMed  CAS  Google Scholar 

  88. Rossetti G, Brusciano L, Amato G, Maffettone V, Napolitano V, Russo G, Izzo D, Russo F, Pizza F, Del Genio G, Del Genio A (2005) A total fundoplication is not an obstacle to esophageal emptying after Heller myotomy for achalasia: results of a long-term follow up. Ann Surg 241:614–621

    Article  PubMed  Google Scholar 

  89. Kumar V, Shimi SM, Cuschieri A (1998) Does laparoscopic cardiomyotomy require an antireflux procedure? Endoscopy 30:8–11

    Article  PubMed  CAS  Google Scholar 

  90. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240:405–412

    Article  PubMed  Google Scholar 

  91. Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M (2008) Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 248:1023–1030

    Article  PubMed  Google Scholar 

  92. Rawlings A, Soper N, Oelschlager B, Swanstrom L, Matthews BD, Pellegrini C, Pierce RA, Pryor A, Martin V, Frisella MM, Cassera M, Brunt LM (2011) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective randomized-controlled trial. Surg Endosc 25:S210

    Google Scholar 

  93. Engstrom C, Lonroth H, Mardani J, Lundell L (2007) An anterior or posterior approach to partial fundoplication? Long-term results of a randomized trial. World J Surg 31:1221–1225; discussion 1226–1227

    Article  PubMed  CAS  Google Scholar 

  94. Hagedorn C, Jonson C, Lonroth H, Ruth M, Thune A, Lundell L (2003) Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, controlled clinical trial. Ann Surg 238:189–196

    PubMed  Google Scholar 

  95. Stefanidis D, Hope WW, Kohn GP, Reardon PR, Richardson WS, Fanelli RD (2010) Guidelines for surgical treatment of gastroesophageal reflux disease. Surg Endosc 24(11):2647–2669

    Article  PubMed  Google Scholar 

  96. Zucker KA (2001) Minimally invasive surgery for achalasia. In: Zucker KA (ed) Surgical laparoscopy, 2nd edn. Lippincott Williams & Wilkins, Philadelphia, pp 467–491

    Google Scholar 

  97. Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230:587–593; discussion 593–584

    Article  PubMed  CAS  Google Scholar 

  98. Bonavina L, Nosadini A, Bardini R, Baessato M, Peracchia A (1992) Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. Arch Surg 127:222–226; discussion 227

    Article  PubMed  CAS  Google Scholar 

  99. Black J, Vorbach AN, Collis JL (1976) Results of Heller’s operation for achalasia of the oesophagus. The importance of hiatal repair. Br J Surg 63:949–953

    Article  PubMed  CAS  Google Scholar 

  100. Simic AP, Radovanovic NS, Skrobic OM, Raznatovic ZJ, Pesko PM (2010) Significance of limited hiatal dissection in surgery for achalasia. J Gastrointest Surg 14:587–593

    Article  PubMed  Google Scholar 

  101. Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G, Nicoletti L, Cavallin F, Battaglia G, Ruol A, Ancona E (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248:986–993

    Article  PubMed  Google Scholar 

  102. Khajanchee YS, Kanneganti S, Leatherwood AE, Hansen PD, Swanstrom LL (2005) Laparoscopic Heller myotomy with Toupet fundoplication: outcomes predictors in 121 consecutive patients. Arch Surg 140:827–833; discussion 833–834

    Article  PubMed  Google Scholar 

  103. Schuchert MJ, Luketich JD, Landreneau RJ, Kilic A, Gooding WE, Alvelo-Rivera M, Christie NA, Gilbert S, Pennathur A (2008) Minimally invasive esophagomyotomy in 200 consecutive patients: factors influencing postoperative outcomes. Ann Thorac Surg 85:1729–1734

    Article  PubMed  Google Scholar 

  104. Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG (2008) The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 12:159–165

    Article  PubMed  Google Scholar 

  105. Mineo TC, Pompeo E (2004) Long-term outcome of Heller myotomy in achalasic sigmoid esophagus. J Thorac Cardiovasc Surg 128:402–407

    Article  PubMed  Google Scholar 

  106. Gorodner MV, Galvani C, Fisichella PM, Patti MG (2004) Preoperative lower esophageal sphincter pressure has little influence on the outcome of laparoscopic Heller myotomy for achalasia. Surg Endosc 18:774–778

    Article  PubMed  CAS  Google Scholar 

  107. Pechlivanides G, Chrysos E, Athanasakis E, Tsiaoussis J, Vassilakis JS, Xynos E (2001) Laparoscopic Heller cardiomyotomy and Dor fundoplication for esophageal achalasia: possible factors predicting outcome. Arch Surg 136:1240–1243

    Article  PubMed  CAS  Google Scholar 

  108. Rakita SS, Villadolid D, Kalipersad C, Thometz D, Rosemurgy A (2007) BMI affects presenting symptoms of achalasia and outcome after Heller myotomy. Surg Endosc 21:258–264

    Article  PubMed  CAS  Google Scholar 

  109. Guardino JM, Vela MF, Connor JT, Richter JE (2004) Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. J Clin Gastroenterol 38:855–860

    Article  PubMed  Google Scholar 

  110. Duffy PE, Awad ZT, Filipi CJ (2003) The laparoscopic reoperation of failed Heller myotomy. Surg Endosc 17:1046–1049

    Article  PubMed  CAS  Google Scholar 

  111. Gorecki PJ, Hinder RA, Libbey JS, Bammer T, Floch N (2002) Redo laparoscopic surgery for achalasia. Surg Endosc 16:772–776

    Article  PubMed  CAS  Google Scholar 

  112. Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S, Way LW (2001) Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg 136:870–877

    Article  PubMed  CAS  Google Scholar 

  113. Gockel I, Kneist W, Eckardt VF, Oberholzer K, Junginger T (2004) Subtotal esophageal resection in motility disorders of the esophagus. Dig Dis 22:396–401

    Article  PubMed  Google Scholar 

  114. Nehra D, Lord RV, DeMeester TR, Theisen J, Peters JH, Crookes PF, Bremner CG (2002) Physiologic basis for the treatment of epiphrenic diverticulum. Ann Surg 235:346–354

    Article  PubMed  Google Scholar 

  115. Reznik SI, Rice TW, Murthy SC, Mason DP, Apperson-Hansen C, Blackstone EH (2007) Assessment of a pathophysiology-directed treatment for symptomatic epiphrenic diverticulum. Dis Esophagus 20:320–327

    Article  PubMed  CAS  Google Scholar 

  116. Rosati R, Fumagalli U, Bona S, Bonavina L, Peracchia A (1998) Diverticulectomy, myotomy, and fundoplication through laparoscopy: a new option to treat epiphrenic esophageal diverticula? Ann Surg 227:174–178

    Article  PubMed  CAS  Google Scholar 

  117. Honda H, Kume K, Tashiro M, Sugihara Y, Yamasaki T, Narita R, Yoshikawa I, Otsuki M (2003) Early stage esophageal carcinoma in an epiphrenic diverticulum. Gastrointest Endosc 57:980–982

    Article  PubMed  Google Scholar 

  118. Streitz JM Jr, Ellis FH Jr, Gibb SP, Heatley GM (1995) Achalasia and squamous cell carcinoma of the esophagus: analysis of 241 patients. Ann Thorac Surg 59:1604–1609

    Article  PubMed  Google Scholar 

  119. Klaus A, Hinder RA, Swain J, Achem SR (2003) Management of epiphrenic diverticula. J Gastrointest Surg 7:906–911

    Article  PubMed  Google Scholar 

  120. Duda M, Sery Z, Vojacek K, Rocek V, Rehulka M (1985) Etiopathogenesis and classification of esophageal diverticula. Int Surg 70:291–295

    PubMed  CAS  Google Scholar 

  121. D’Ugo D, Cardillo G, Granone P, Coppola R, Margaritora S, Picciocchi A (1992) Esophageal diverticula. Physiopathological basis for surgical management. Eur J Cardiothorac Surg 6:330–334

    Article  PubMed  Google Scholar 

  122. Valentini M, Pera M, Vidal O, Lacima G, Belda J, de Lacy AM (2005) Incomplete esophageal myotomy and early recurrence of an epiphrenic diverticulum. Dis Esophagus 18:64–66

    Article  PubMed  CAS  Google Scholar 

  123. Streitz JM Jr, Glick ME, Ellis FH Jr (1992) Selective use of myotomy for treatment of epiphrenic diverticula. Manometric and clinical analysis. Arch Surg 127:585–587; discussion 587–588

    Article  PubMed  Google Scholar 

  124. Rice TW, McKelvey AA, Richter JE, Baker ME, Vaezi MF, Feng J, Murthy SC, Mason DP, Blackstone EH (2005) A physiologic clinical study of achalasia: should Dor fundoplication be added to Heller myotomy? J Thorac Cardiovasc Surg 130:1593–1600

    Article  PubMed  Google Scholar 

  125. Del Genio A, Rossetti G, Maffetton V, Renzi A, Brusciano L, Limongelli P, Cuttitta D, Russo G, Del Genio G (2004) Laparoscopic approach in the treatment of epiphrenic diverticula: long-term results. Surg Endosc 18:741–745

    PubMed  CAS  Google Scholar 

  126. Fraiji E Jr, Bloomston M, Carey L, Zervos E, Goldin S, Banasiak M, Wallace M, Rosemurgy AS (2003) Laparoscopic management of symptomatic achalasia associated with epiphrenic diverticulum. Surg Endosc 17:1600–1603

    Article  PubMed  Google Scholar 

  127. Peillon C, Fromont G, Auvray S, Siriser F (2001) Achalasia: the case for primary laparoscopic treatment. Surg Laparosc Endosc Percutan Tech 11:71–75

    PubMed  CAS  Google Scholar 

  128. Bonavina L, Incarbone R, Reitano M, Antoniazzi L, Peracchia A (2000) Does previous endoscopic treatment affect the outcome of laparoscopic Heller myotomy? Ann Chir 125:45–49

    Article  PubMed  CAS  Google Scholar 

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Disclosures

Drs. Stefanidis, Richardson, Farrell, Kohn, Augenstein, and Fanelli have no conflicts of interest or financial ties relevant to this publication to disclose.

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Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Department of General Surgery, Carolinas HealthCare System, CMC Specialty Surgery Center Suite 300, 1025 Morehead Medical Plaza, Charlotte, NC, 28204, USA

    Dimitrios Stefanidis & Vedra Augenstein

  2. Ochsner Clinic Foundation, New Orleans, LA, USA

    William Richardson

  3. University of North Carolina, Chapel Hill, NC, USA

    Timothy M. Farrell

  4. Knox Private Hospital, Victoria, Australia

    Geoffrey P. Kohn

  5. Berkshire Medical Center, Pittsfield, MA, USA

    Robert D. Fanelli

Authors
  1. Dimitrios Stefanidis
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  2. William Richardson
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  3. Timothy M. Farrell
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  4. Geoffrey P. Kohn
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  5. Vedra Augenstein
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  6. Robert D. Fanelli
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Correspondence to Dimitrios Stefanidis.

Appendix

Appendix

This document was prepared and revised by the SAGES Guidelines Committee:

Dimitrios Stefanidis, MD (Co-Chair)

Timothy M. Farrell, MD

Geoffrey P. Kohn, MD

William S. Richardson, MD (Co-Chair)

Robert D. Fanelli, MD, FACS (Chair)

Vedra Augenstein, MD

Ziad T. Awad, MD

Simon Bergman, MD

Ronald H. Clements, MD

David B. Earle, MD

David S. Edelman, MD

Liane S. Feldman, MD

Erika K. Fellinger, MD

Shannon A. Fraser, MD

Stephen P. Haggerty, MD

William W. Hope, MD

Ifeoma J. Igboeli, MD

Geoffrey P. Kohn, MD

Henry J. Lujan, MD

Lisa R. Martin Hawver, MD

Sumeet K. Mittal, MD

Erica A. Moran, MD

David W. Overby, MD

Jonathan P. Pearl, MD

Raymond R. Price, MD

Kurt E. Roberts, MD

John S. Roth, MD

Alan A. Saber, MD

J. R. Salameh, MD

Andrew S. Wright, MD

Jin S. Yoo, MD

Joerg Zehetner, MD

Marc Zerey, MD

It was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), May 2011.

Requests for prints should be sent to: Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), 11300 West Olympic Blvd., Suite 600, Los Angeles, CA 90064; Tel.: (310) 437-0544; Fax: (310) 437 0585; E-mail: publications@sages.org; http://www.sages.org/

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Stefanidis, D., Richardson, W., Farrell, T.M. et al. SAGES guidelines for the surgical treatment of esophageal achalasia. Surg Endosc 26, 296–311 (2012). https://doi.org/10.1007/s00464-011-2017-2

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  • DOI: https://doi.org/10.1007/s00464-011-2017-2

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