The Outcome of Laparoscopic Surgery With and Without Short Gastric Vessel Division for Achalasia
Yasunori AkutsuNaoyuki HanariTsuguaki KonoMasaya UesatoIsamu HoshinoKentaro MurakamiToshiyuki NatsumeYuka IsozakiNaoki AkanumaTakeshi ToyozumiHiroshi SuitoHisahiro Matsubara
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Short gastric vessel division (SGVD) has been performed as a part of fundoplication for achalasia. However, whether or not SGVD is necessary is still unknown. Forty-six patients with achalasia who underwent a laparoscopic surgery with or without SGVD were analyzed. A questionnaire was administered to assess the postoperative improvement. Regarding improvement of dysphagia and postoperative reflux, there were no significant differences between SGVD (+) group and SGVD (-) group (P = 0.588 and P = 0.686, respectively). Nineteen patients (95%) in the SGVD (+) group and 24 (92%) in the SGVD (-) group answered that the surgery was satisfactory (P = 0.756). In the SGVD (+) group, the pre- and postsurgical body weight increase was +7.3%. In the SGVD (-) group, it was 8.2%. There was no significant difference of body weight increase between the 2 groups (P = 0.354). SGVD is not always required in laparoscopic surgery for achalasia.The following on achalasia and disorders of the esophageal body includes commentaries on controversies regarding whether patients with complete lower esophageal sphincter (LES) relaxation can be considered to exhibit early achalasia; the roles of different mucle components of the LES in achalasia; sensory neural pathways impaired in achalasia; indications for peroral endoscopic myotomy and advantages of the technique over laparoscopic and thorascopic myotomy; factors contributing to the success of surgical therapy for achalasia; modifications to the classification of esophageal body primary motility disorders in the advent of high-resolution manometry (HRM); analysis of the LES in differentiating between achalasia and diffuse esophageal spasm (DES); and appropriate treatment for DES, nutcracker esophagus (NE), and hypertensive LES (HTLES).
Esophageal motility disorder
Esophageal sphincter
Esophageal spasm
High resolution manometry
Heller myotomy
Esophageal Disorder
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A case of achalasia associated with squamous cell carcinoma of the esophagus is presented. Microscopic examination of the resected esophagus demonstrated abundant nerve fibers but absent ganglion cells throughout the tumor-involved segment. This finding is believed to be the cause of achalasia in this patient.
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The aim of the study was to characterize the presence of diverse CD4 and CD8 T cell subsets and regulatory cells in peripheral blood and lower oesophageal sphincter (LES) from a young patient with BE/achalasia without treatment versus achalasia group. In order to characterize the circulating cells in this patient, a cytometric analysis was performed. LES tissue was evaluated by double-immunostaining procedure. Five healthy blood donors, 5 type achalasia patients, and 5 oesophagus tissue samples (gastrooesophageal junction) from transplant donors were included as control groups. A conspicuous systemic inflammation was determined in BE/achalasia patient and achalasia versus healthy volunteer group. Nonetheless, a predominance of Th22, Th2, IFN-α-producing T cells, Tregs, Bregs, and pDCregs was observed in BE/achalasia patient versus achalasia group. A low percentage of Th1 subset in BE/achalasia versus achalasia group was determined. A noticeable increase in tissue of Th22, Th17, Th2, Tregs, Bregs, and pDCregs was observed in BE/achalasia versus achalasia group. Th1 subset was lower in the BE/achalasia patient versus achalasia group. This study suggests that inflammation is a possible factor in the pathogenesis of BE/achalasia. Further research needs to be performed to understand the specific cause of the correlation between BE and achalasia.
Barrett's oesophagus
Esophageal sphincter
Esophagogastric junction
Pathogenesis
High resolution manometry
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Esophageal manometry is a valuable tool in the diagnosis of achalasia. The manometric features proposed for diagnosing classic achalasia are incomplete relaxation of the lower esophageal sphincter and aperistalsis in the body of the esophagus. Atypical achalasia cases have been reported that do not have the characteristic manometric features of classic achalasia. We report the clinical, radiological and manometric follow-up of a 45-year- old woman who presented with atypical manometric features of achalasia that have not been reported in the literature and who after a short period demonstrated the manometric features of classical achalasia.
Esophageal sphincter
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<b><i>Background:</i></b> Favorable outcomes of laparoscopic surgery for gallbladder cancer (GBC) have been reported; yet consensus on the indications and surgical techniques for laparoscopic surgery for GBC is lacking. <b><i>Objective:</i></b> To evaluate the current status of laparoscopic surgery for GBC by analyzing the results of a survey of experts and by reviewing the relevant published literature. <b><i>Methods:</i></b> Before an expert meeting was held on September 10, 2016 in Seoul, Korea, an international survey was undertaken of expert surgeons in the field of GBC surgery. <b><i>Results:</i></b> The majority of surgeons who responded agreed that laparoscopic surgery has an acceptable role for suspicious or early GBC, and that laparoscopic extended cholecystectomy has a value comparable to that of open surgery in selected patients with GBC. However, the selection criteria for laparoscopic surgery for overt GBC and the details of the surgical techniques varied among surgeons. <b><i>Conclusions:</i></b> This survey and literature review revealed that laparoscopic surgery for GBC is performed in highly selected cases. However, the favorable outcomes in the published reports and the positive view of experienced surgeons for this operative procedure suggest a high likelihood that laparoscopic surgery will be more frequently performed for GBC in the future.
Gallbladder Cancer
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postoperative patients with achalasia (male 23 cases, female 25 cases)with achalasia were evaluated by symptoms and esophageal manometry. Mean age was 41 years old and mean following-up during was 15 years. Results: Operation was a effective meathod in treatment for achalasia. Heller's operation should be the first operative measure. LESP affected effects and gastro-esophageal reflux after operation.
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在过去几年里的食道的 achalasia 的诊断和治疗有一些突破。首先，有作为一个新诊断工具阴谋的压力地形学的高分辨率的 manometry 的介绍使分类 achalasia 进三种子类型可能。最有利的结果为为类型 II achalasia (有压缩的 achalasia ) 接受治疗的病人被预言。有 typeI (经典 achalasia ) 和类型 III achalasia (痉挛 achalasia ) 的病人经历不太有利的结果。第二，第一 multicenter 使随机化欧洲 Achalasia 试用组出版的控制试用报导 2 年的后续结果显示那 laparoscopic Heller 肌切开术不比内视镜的灵魂膨胀(PD ) 优异。尽管后续时期不足够长得出一个有说服力的结论，它在肠胃病学作为一种通常可得到的技术应得 PD 的继续的使用。第三，新奇内视镜的技术 peroral 内视镜的肌切开术是为对待 achalasia 的一种有希望的选择，但是它要求增加的经验和小心的评估。尽管有所有这些好消息，底线是从基本研究的真实突破鉴别可以阻碍治疗成功的 achalasia 的实际原因仍然被期望。
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Esophageal sphincter
Heller myotomy
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