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Heller Cardiomyotomy


Presentation

  • She recovered well and remained asymptomatic for 5 years when she presented with mild dysphagia and occasional vomiting.[jpss.eu]
  • Previous medical management may present a greater technical challenge and may place patients at increased risk of mucosal injury.[ncbi.nlm.nih.gov]
  • The classic presentation is difficulty in swallowing and vomiting of undigested food, and children can often present with chest pain. In some instances, these symptoms can lead to considerable weight loss.[indianhealthjournal.wordpress.com]
Asymptomatic
  • After a mean follow-up period of 9.4 (range 3-17) months, 4 patients remained completely asymptomatic, and 1 patient has benefited from symptomatic improvement.[ncbi.nlm.nih.gov]
  • 463 Thymectomy for Myasthenia Gravis Optimal Approach 469 Management of Residual Disease after Therapy for Mediastinal Germ Cell Tumor and Normal Serum Markers 474 Management of Malignant Pericardial Effusions 482 Asymptomatic Pericardial Cyst Observe[books.google.com]
  • She recovered well and remained asymptomatic for 5 years when she presented with mild dysphagia and occasional vomiting.[jpss.eu]
  • After a mean follow-up period of 9.4 (range 3–17) months, 4 patients remained completely asymptomatic, and 1 patient has benefited from symptomatic improvement.[karger.com]
  • Pagina 6 - Dent J, Dodds WJ, Friedman RH, Sekiguchi T, Hogan WJ, Arndorfer RC, Petrie DJ (1980) Mechanism of gastroesophageal reflux in recumbent asymptomatic human subjects. ‎[books.google.ro]
Swelling
  • Inform your doctor immediately if you experience fever over 101 F, nausea or vomiting for 24 hours, constipation or diarrhea for over 48 hours, or swelling, redness and odorous drainage from the incisions.[nmcsurgery.ae]
  • Your are not making urine as you were before your operation You develop worsening swelling in your legs or have sudden shortness of breath. This could be a sign of blood clots.[augusta.edu]
Malignant Pleural Effusion
  • Pleural Effusion Optimal Sclerosing Agent 409 Management of Malignant Pleural Effusion Sclerosis or Chronic Tube Drainage 414 Initial Spontaneous Pneumothorax Role of Thoracoscopic Therapy 424 Intrapleural Fibrinolytics 433 Diffuse Malignant Pleural[books.google.com]
Failure to Thrive
  • Case report: A 6 month old baby presented to us with persistent vomiting from 2 months of age and failure to thrive. He weighed 4 kg at 6 month of age. His other systemic examinations were normal.[indianhealthjournal.wordpress.com]
  • Symptoms may progress to chest pain, emesis, aspiration, weight loss, and failure to thrive[ 8 ]. Table 1 summarizes common symptoms and associated conditions of achalasia in children.[wjgnet.com]
Persistent Vomiting
  • Case report: A 6 month old baby presented to us with persistent vomiting from 2 months of age and failure to thrive. He weighed 4 kg at 6 month of age. His other systemic examinations were normal.[indianhealthjournal.wordpress.com]
Distractibility

Workup

  • […] sensitivity, esophageal manometry (esophageal motility study) is considered the key test for establishing the diagnosis of achalasia.We frequently see patients coming with recurrence of symptoms after surgery or endoscopic dilatation and with incomplete workup[drchiragthakkar.com]
Pericardial Effusion
  • 463 Thymectomy for Myasthenia Gravis Optimal Approach 469 Management of Residual Disease after Therapy for Mediastinal Germ Cell Tumor and Normal Serum Markers 474 Management of Malignant Pericardial Effusions 482 Asymptomatic Pericardial Cyst Observe[books.google.com]

Treatment

  • The goal of the treatment is to relieve functional out flow obstruction caused by loss of relaxation and compliance of LES. Endoscopic management is proved to be effective and safe modality.[medicaljournalofcairouniversity.net]
  • Abstract Laparoscopic cardiomyotomy is an effective treatment for achalasia. Intraoperative leak tests are carried out to exclude mucosal perforations, additionally some surgeon perform postoperative contrast swallows.[ncbi.nlm.nih.gov]
  • It has always been the endeavor of SaiShree to offer quality treatment at affordable cost without compromising the comfort level of patients.[saishreehospital.org]
  • There are no literature supporting such treatment in a 6 month old infant.[indianhealthjournal.wordpress.com]

Etiology

  • The primary indication for Heller myotomy is benign achalasia with dysphagia. [3] Achalasia is a relatively rare condition (prevalence approximately 1/100,000 in Western countries [1] ), and the etiology is usually unknown.[emedicine.medscape.com]
  • First, we thought that it was important to classify the etiology of achalasia as chagasic or idiopathic because Chagas disease is very common in Brazil.[misjournal.net]
  • Gastroenterology 135:1526–1533 Google Scholar Park W, Vaezi MF (2005) Etiology and pathogenesis of achalasia: the current understanding.[link.springer.com]
  • Depending on its etiology, it can be classified as idiopathic, chagasic, pseudoachalasia or associated with syndromic diseases.[scielo.br]
  • The etiology of achalasia is unclear, but the functional disturbances in adult patients are well known: lack or incompleteness of deglutitory relaxation of the lower esophageal sphincter (LES), absent or disorganized peristalsis and, frequently, increased[hon.ch]

Epidemiology

  • Epidemiology and demographics of achalasia. Gastrointest Endosc Clin North Am. 2001; 11(2):235-48. [ Links ] 3. Pilon B, Teixeira FV, Terrazas JP, Moreira EP, Pillon EY.[scielo.br]
  • Achalasia: A review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2013. 21;19(35):5806-5812. Hirano I. Pathophysiology of achalasia and diffuse esophageal spasm. GI Motility Online. 2006; doi: 10.1038/gimo22.[bjmp.org]
Sex distribution
Age distribution

Pathophysiology

  • Knowledge concerning oesophageal pathophysiology has until recently lagged far behind that of the pathophysiology of other portions of the gastrointestinal (GI) tract for reasons that still remain unclear.[books.google.com]
  • Belching 414 References 421 References 427 751 430 Benign Tumors and Cysts of the Esophagus By G WANTRAPPEN and J PRINGOT With 431 Intraluminal Tumors 443 Pseudosarcoma and Carcinosarcoma 485 Chapter 5 493 Clinical Features 504 Endoscopy 514 References 521 Pathophysiology[books.google.ro]
  • The pathophysiology is likely secondary to abnormal innervations (inhibitory nonadrenergic, noncholinergic ganglion cell degeneration, and neural fibrosis) of the myenteric plexus.[emedicine.medscape.com]
  • Pathophysiology of achalasia and diffuse esophageal spasm. GI Motility Online. 2006; doi: 10.1038/gimo22. Hirano I. Pathophysiology of achalasia and diffuse esophageal spasm. Table 1 - Classification of secondary causes of achalasia.[bjmp.org]
  • McPhee SJ, Ganong WF (eds) (2006) Pathophysiology of Disease: An Introduction to Clinical Medicine, 5th Edition. The McGraw-Hill Companies, New York Google Scholar 21.[springerlink.com]

Prevention

  • This is usually followed by a partial fundoplication to prevent reflux following the surgery. The surgery allows food to pass easily into the stomach.[nmcsurgery.ae]
  • To prevent this, the upper part of the stomach is taken and wrapped around the cut portion of the esophagus. This is known as the ‘Dor Procedure’. Heller’s procedure is minimally invasive and provides prompt recovery.[limakeyholesurgery.com]
  • At the lower end of this tube there is a valve like mechanism which prevent reflux of acid from stomach into esophagus. In order to allow food into stomach, this valve relaxes in response to swallowing.[obesitydiabetessurgery.com]
  • Further, a Dor fundoplication (a partial wrapping of the stomach around the esophagus to make a low-pressure valve) is performed to prevent reflux from the stomach into the esophagus following the myotomy.[memorialhermann.org]
  • Thus surgery has an advantage of adding a antireflux procedure with cardiomyotomy and prevent GERD and antacid requirement.[drchiragthakkar.com]

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