TY - JOUR
T1 - Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia
T2 - Multicenter study
AU - Horgan, Santiago
AU - Galvani, Carlos
AU - Gorodner, Maria V.
AU - Omelanczuck, Pablo
AU - Elli, Fernando
AU - Moser, Federico
AU - Durand, Luis
AU - Caracoche, Miguel
AU - Nefa, Jorge
AU - Bustos, Sergio
AU - Donahue, Phillip
AU - Ferraina, Pedro
N1 - Funding Information:
Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14-18, 2005 (oral presentation). From Minimally Invasive Surgery, University of Illinois, Chicago, Illinois (S.H., C.G., M.V.G., F.M., P.D.), Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina (F.E., L.D., M.C., P.F.), and Hospital Italiano, Mendoza, Argentina (P.O., J.N., S.B.). This study was supported in part by a grant provided by Intuitive Surgical, Inc. and Ethicon Endo-Surgery, Inc. Reprint requests: Santiago Horgan, M.D., Minimally Invasive Surgery, 840 South Wood Street, Room 435E, Chicago, IL 60612 e-mail: shorgan@uic.edu
PY - 2005/11/1
Y1 - 2005/11/1
N2 - Laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. The incidence of esophageal perforation reported is about 5%-10%. Robotically assisted Heller myotomy (RAHM) is emerging as a safe alternative to LHM. Data comparing the two approaches are scant. The aim of this study was to compare RAHM with LHM in terms of efficacy and safety for treatment of achalasia. A total of 121 patients underwent surgical treatment of achalasia at three institutions. A retrospective review of prospectively collected perioperative data was performed. Patients were divided into two groups: group A (RAHM), 59 patients, and group B (LHM), 62 patients. All the operations were completed using minimally invasive techniques. There were 63 women and 58 men, with a mean age of 45 ± 19 years (14-82 years). Fifty-one percent of patients in group A and 95% of patients in group B reported weight loss. Duration of symptoms was equal for both groups. Dysphagia was the main complaint in both groups (P = NS). There was no difference in preoperative endoscopic treatment in both groups (44% versus 27%, P = NS). Operative time was significantly shorter for LHM in the first half of the experience (141 ± 49 versus 122 ± 44 minutes, P < .05). However, in the last 30 cases there was no difference in operative time between the groups (P = NS). Intraoperative complications (esophageal perforation) were more frequent in group B (16% versus 0%). The incidence of postoperative heartburn did not differ by group. There were no deaths. At 18 and 22 months, 92% and 90% of patients had relief of their dysphagia. This study suggests that RAHM is safer than LHM, because it decreases the incidence of esophageal perforation to 0%, even in patients who had previous treatment. At short-term follow-up, relief of dysphagia was equally achieved in both groups.
AB - Laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. The incidence of esophageal perforation reported is about 5%-10%. Robotically assisted Heller myotomy (RAHM) is emerging as a safe alternative to LHM. Data comparing the two approaches are scant. The aim of this study was to compare RAHM with LHM in terms of efficacy and safety for treatment of achalasia. A total of 121 patients underwent surgical treatment of achalasia at three institutions. A retrospective review of prospectively collected perioperative data was performed. Patients were divided into two groups: group A (RAHM), 59 patients, and group B (LHM), 62 patients. All the operations were completed using minimally invasive techniques. There were 63 women and 58 men, with a mean age of 45 ± 19 years (14-82 years). Fifty-one percent of patients in group A and 95% of patients in group B reported weight loss. Duration of symptoms was equal for both groups. Dysphagia was the main complaint in both groups (P = NS). There was no difference in preoperative endoscopic treatment in both groups (44% versus 27%, P = NS). Operative time was significantly shorter for LHM in the first half of the experience (141 ± 49 versus 122 ± 44 minutes, P < .05). However, in the last 30 cases there was no difference in operative time between the groups (P = NS). Intraoperative complications (esophageal perforation) were more frequent in group B (16% versus 0%). The incidence of postoperative heartburn did not differ by group. There were no deaths. At 18 and 22 months, 92% and 90% of patients had relief of their dysphagia. This study suggests that RAHM is safer than LHM, because it decreases the incidence of esophageal perforation to 0%, even in patients who had previous treatment. At short-term follow-up, relief of dysphagia was equally achieved in both groups.
KW - Complications
KW - Esophageal achalasia
KW - Laparoscopic Heller myotomy
KW - Robotic-assisted Heller myotomy
KW - Swallowing status
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UR - http://www.scopus.com/inward/citedby.url?scp=27644497181&partnerID=8YFLogxK
U2 - 10.1016/j.gassur.2005.06.026
DO - 10.1016/j.gassur.2005.06.026
M3 - Article
C2 - 16269372
AN - SCOPUS:27644497181
SN - 1091-255X
VL - 9
SP - 1020
EP - 1030
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 8
ER -