Volumen 31 No. 2 (2013)

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Browsing Volumen 31 No. 2 (2013) by Subject "Acalasia"

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    Miotomía extendida en el tratamiento de la acalasia
    (Universidad de Cuenca. Facultad de Ciencias Médicas, 2013-07) Astudillo Molina, Rubén Arturo; Serrano Hinojosa, Bolívar Eugenio
    The achalasia is a rare esophageal disease that is accompanied by a significant alteration in patients’ quality of life. Its etiology is not fully clarified and its main clinical features are dysphagia and regurgitation. The treatment for achalasia is led to a functional and symptomatic relief through a lower esophageal sphincter opening, being performed at the time of laparoscopic myotomy, the technique of choice while the pneumatic dilatation and botulinum toxin injection should be considered as technical resources in selected cases. Objective: To evaluate the results of the extended myotomy plus Dorr´s previous and partial fundoplication as the achalasia´s laparoscopic treatment compared with our previous experience using the standard technique. Materials and method: design: Prospective, Descriptive and Longitudinal Study. Host: Hospital Latino, Cuenca - Ecuador. Patients and method: From June 1992 through December 2011, 39 patients with diagnosis of achalasia had surgery and received surgical treatment through minimally invasive surgery. We studied age, previous symptoms, classifications according to Stewart, duration of symptoms, surgical technique performed, postoperative control. Results: 39 patients were operated, average age 66 years, 23 years minimum and 81 years maximum. Dysphagia symptomatology was presented in 100%, regurgitation in 74%, weight loss in 71.8% and odynophagia in 28.2%. The duration of symptoms were: less than 2 years 48.7% (n=19), 2 to 4 years 33.3% (n=13), 4 to 6 years 12.8% (n=5), and 6 to 8 years 5.1% (n=2). According to Stewart, these were classified as follows: I 8% (n=3), II 49% (n=19), III 38% (n=15) and IV 5% (n=2). The used technique was Myotomy + Dorr 57% (n=22), Extended Myotomy + Dorr 20% (n=8), Only Myotomy 18% (n=7), Myotomy + Toupet 5% (n=2). We tracked a 75% of patients, excellent results 91%, and good results 9%. The last eight cases underwent extended myotomy plus Dorr´s fundoplication, providing excellent short-term results. Conclusion: Extended gastric myotomy improves the surgical therapy outcome for achalasia without increasing the rate of abnormal gastro esophageal reflux when a partial previous Dorr´s fundoplication type is added.