1998 Abstract: MINIMALLY INVASIVE SURGERY FOR DIFFUSE ESOPHAGEAL SPASM AND NUTCRACKER ESOPHAGUS. D. Tyrrell, M.G. Patti, M. Arcerito, C. Feo, J. Tong, W. Gantert, and L.W. Way, Department of Surgery, University of California, San Francisco. San Francisco, CA. 58
Abstracts 1998 Digestive Disease Week
#962
MINIMALLY INVASIVE SURGERY FOR DIFFUSE ESOPHAGEAL SPASM AND NUTCRACKER ESOPHAGUS. D. Tyrrell, M.G. Patti, M. Arcerito, C. Feo, J. Tong, W. Gantert, and L.W. Way, Department of Surgery, University of California, San Francisco. San Francisco, CA.
Background: The efficacy of minimally invasive surgery has now been well documented for achalasia, but the experience with other esophageal motor disorders has just reached the point where valid generalizations can be made.
Goals: To determine the results of minimally invasive surgery for diffuse esophageal spasm and nutcracker esophagus.
Patients and Methods: DES (26 pts) or NE (48 pts) was present in 76 (5%) of 1550 pts with foregut symptoms evaluated at the UCSF Swallowing Center. All pts had a barium swallow, endoscopy, stationary esophageal manometry and pH monitoring. Ambulatory manometry was performed in pts with chest pain as a major complaint. Eight pts with DES had long thoracoscopic myotomies (6 pts) or laparoscopic myotomy and Dor fundoplication (2 pts). A large epiphrenic diverticulum was resected laparoscopically in 1 pt in addition to the myotomy. Six pts with NE had long right thoracoscopic myotomies. Average follow-up was 51 months (range 4-78 months).
Results:
Preoperative
Postoperative
p-value
DES (8 pts)
Dysphagia 8 pts (score 0-4)
3.5 ± 0.535
0.5 ± 1.4
< 0.016
Distal esophageal amplitude (mmHg)
2.3 ± 1.2
0.0 ± 0
NS
NE (6 pts)
Dysphagia 6 pts (score 0-4)
3.0 ± 063
0.833 ± 1.33
NS
Chest pain 6 pts (score 0-4)
3.5 ± 0.55
1.33 ± 1.75
NS
Conclusions: These results show that: (a) Minimally invasive surgery was effective for dysphagia secondary to DES. (b) The response of chest pain in NE was less predictable, although 4 pts obtained complete relief. (c) A long myotomy of the body of the esophagus must extend far enough to include at least part of the sphincter; otherwise the intact distal esophagus may cause partial obstruction. In conclusion, the entire spectrum of operations required to treat these disorders can be performed safely and effectively by minimally invasive methods.
Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.
