Tratamiento laparoscópico de la acalasia en un centro de baja frecuencia
Palabras clave:
ACALASIA DEL ESÓFAGO, LAPAROSCOPÍA
Resumen
Introducción: el tratamiento laparoscópico de la acalasia esofágica brinda excelentes resultados funcionales en el corto y largo plazo. En Uruguay, por razones demográficas y la baja prevalencia de la enfermedad, el número de pacientes operados anualmente es bajo.
Objetivo: analizar los resultados del tratamiento quirúrgico de la acalasia mediante abordaje video laparoscópico.
Material y método: estudio observacional descriptivo, retrospectivo, de una serie de casos integrada por todos los pacientes operados en la Clínica Quirúrgica 3 del Hospital Maciel en un período de 108 meses (2002-2010), en el cual se operaron 17 pacientes (14 mujeres, 3 hombres; edad media: 34 años) y con 24 meses promedio de duración de síntomas que cumplieron los criterios clínicos, endoscópicos, radiológicos y manométricos para diagnóstico de acalasia y a los cuales se les realizó esofagomiotomía asociada a un procedimiento antirreflujo tipo Toupet.
Resultados: el tiempo operatorio fue de 120 minutos. No hubo conversiones a cirugía laparotómica. Una perforación mucosa intraoperatoria. La mortalidad fue nula. Los resultados funcionales fueron excelentes. Seguimiento promedio: dos años.
Conclusiones: el tratamiento laparoscópico de la acalasia es una alternativa segura, efectiva y confortable, que puede realizarse en nuestro medio con resultados funcionales ajustados a la literatura internacional, baja morbilidad y sin mortalidad.
Citas
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(2) Williams VA, Peters JH. Achalasia of the esophagus: a surgical disease. J Am Coll Surg 2009; 208(1):151-62.
(3) Mayberry JF. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am 2001; 11(2):235-48.
(4) Pinotti HW, Nasi A, Domene CD, Santo MA, Telles Libanori H. Tratamiento laparoscópico de la acalasia esofágica. Disponible en: http://www.cirugest.com/htm/revisiones/cir01-07/cap31.pdf Consulta: 14 de junio de 2012.
(5) Universidad de la República. Facultad de Medicina. Departamento de Parasitología y Micología. Sección Chagas. Enfermedad de Chagas. Montevideo: de Parasitología y Micología. Sección Chagas, 2007. Disponible en: http://www.smu.org.uy/dpmc/hmed/historia/articulos/chagas.pdf Consulta: 14 de junio de 2012.
(6) Heller F. Extramukose kardiaplastik bein chronischen kardiospasms nut dilatation des oesophagus. Mett Grensgeb Med Chir 1914; 27:141-29.
(7) Zaaijer JH. Cardiospasm in the aged. Ann Surg 1923; 77(5):615-7.
(8) Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 2004; 240(3):405-12.
(9) Rice TW, McKelvey AA, Richter JE, Baker ME, Vaezi MF, Feng J, et al. A physiologic clinical study of achalasia: should Dor fundoplication be added to Heller myotomy? J Thorac Cardiovasc Surg 2005; 130(6):1593-600.
(10) Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg 2004; 239(3):364-70.
(11) Csendes A, Velasco N, Braghetto I, Henriquez A. A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology 1981; 80(4):789-95.
(12) Csendes A, Braghetto I, Henríquez A, Cortés C. Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut 1989; 30(3):299-304.
(13) Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henríquez A. Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg 2006; 243(2):196-203.
(14) Kostic S, Kjellin A, Ruth M, Lönroth H, Johnsson E, Andersson M, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg 2007; 31(3):470-8.
(15) Annese V, Bassotti G, Coccia G, Dinelli M, D'Onofrio V, Gatto G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 2000; 46(5):597-600.
(16) Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2):205-13.
(17) Visick AH. A study of the failures after gastrectomy. Ann R Coll Surg Engl 1948; 3(5):266-84.
(18) Praderi LA, Balboa O, Ricciardi N. Megaesófago, acalasia: nuestra experiencia. Cir Urug 1982; 52(4):323-33.
(19) Perrier JP, Fernández M, Sosa MC. Tratamiento quirúrgico de la acalasia y la opción de la cirugía laparoscópica. Cir Urug 2000; 70(1):36-44.
(20) Rodríguez G, Fernández G, Gatti A, Balboa O. Cirugía del hiato esofágico: abordaje video laparoscópico. Cir Urug 2003; 73(1):68-91.
(21) Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc 2007; 21(5):713-8.
(22) Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003; 138(5):490-5; discussion 495-7.
(23) Ellis FH Jr, Crozier RE, Gibb SP. Reoperative achalasia surgery. J Thorac Cardiovasc Surg 1986; 92(5):859-65. Erratum in: J Thorac Cardiovasc Surg 1987; 93(4):559.
(24) Malthaner RA, Tood TR, Miller L, Pearson FG. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg 1994; 58(5):1343-6; discussion 1346-7.
(25) Dor J, Humbert P, Dor V, Figarella J. L'interet de la technique de Nissen modifiee dans la prevention de reflux apres cardiomyotomie extramuqueuse de Heller. Mem Acad Chir (Paris) 1962; 88:877-83.
(26) Bonavina L, Nosadini A, Bardini R, Baessato M, Peracchia A. Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. Arch Surg 1992; 127(2):222-6.
(27) Zhu ZJ, Chen LQ, Duranceau A. Long-term result of total versus partial fundoplication after esophagomyotomy for primary esophageal motor disorders. World J Surg 2008; 32(3):401-7.
(28) Donahue PE, Schlesinger PK, Sluss KF, Richter HM, Liu KJ, Rypins EB, et al. Esophagocardiomyotomy-floppy Nissen fundoplication effectively treats achalasia without causing esophageal obstruction. Surgery 1994; 116(4):719-24.
(29) Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor undoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 2008; 248(6):1023-30.
(30) Orringer MB, Stirling MC. Esophageal resection for achalasia: indications and results. Ann Thorac Surg 1989; 47(3):340-5.
(31) Pinotti HW, Cecconello I, da Rocha JM, Zilberstein B. Resection for achalasia of the esophagus. Hepatogastroenterology 1991; 38(6):470-3.
(32) Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 1999; 230(4):587-93.
(33) Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 2008; 12(1):159-65.
(2) Williams VA, Peters JH. Achalasia of the esophagus: a surgical disease. J Am Coll Surg 2009; 208(1):151-62.
(3) Mayberry JF. Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am 2001; 11(2):235-48.
(4) Pinotti HW, Nasi A, Domene CD, Santo MA, Telles Libanori H. Tratamiento laparoscópico de la acalasia esofágica. Disponible en: http://www.cirugest.com/htm/revisiones/cir01-07/cap31.pdf Consulta: 14 de junio de 2012.
(5) Universidad de la República. Facultad de Medicina. Departamento de Parasitología y Micología. Sección Chagas. Enfermedad de Chagas. Montevideo: de Parasitología y Micología. Sección Chagas, 2007. Disponible en: http://www.smu.org.uy/dpmc/hmed/historia/articulos/chagas.pdf Consulta: 14 de junio de 2012.
(6) Heller F. Extramukose kardiaplastik bein chronischen kardiospasms nut dilatation des oesophagus. Mett Grensgeb Med Chir 1914; 27:141-29.
(7) Zaaijer JH. Cardiospasm in the aged. Ann Surg 1923; 77(5):615-7.
(8) Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 2004; 240(3):405-12.
(9) Rice TW, McKelvey AA, Richter JE, Baker ME, Vaezi MF, Feng J, et al. A physiologic clinical study of achalasia: should Dor fundoplication be added to Heller myotomy? J Thorac Cardiovasc Surg 2005; 130(6):1593-600.
(10) Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg 2004; 239(3):364-70.
(11) Csendes A, Velasco N, Braghetto I, Henriquez A. A prospective randomized study comparing forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Gastroenterology 1981; 80(4):789-95.
(12) Csendes A, Braghetto I, Henríquez A, Cortés C. Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia. Gut 1989; 30(3):299-304.
(13) Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henríquez A. Very late results of esophagomyotomy for patients with achalasia: clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg 2006; 243(2):196-203.
(14) Kostic S, Kjellin A, Ruth M, Lönroth H, Johnsson E, Andersson M, et al. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. Results of a randomized controlled trial. World J Surg 2007; 31(3):470-8.
(15) Annese V, Bassotti G, Coccia G, Dinelli M, D'Onofrio V, Gatto G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group. Gut 2000; 46(5):597-600.
(16) Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240(2):205-13.
(17) Visick AH. A study of the failures after gastrectomy. Ann R Coll Surg Engl 1948; 3(5):266-84.
(18) Praderi LA, Balboa O, Ricciardi N. Megaesófago, acalasia: nuestra experiencia. Cir Urug 1982; 52(4):323-33.
(19) Perrier JP, Fernández M, Sosa MC. Tratamiento quirúrgico de la acalasia y la opción de la cirugía laparoscópica. Cir Urug 2000; 70(1):36-44.
(20) Rodríguez G, Fernández G, Gatti A, Balboa O. Cirugía del hiato esofágico: abordaje video laparoscópico. Cir Urug 2003; 73(1):68-91.
(21) Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc 2007; 21(5):713-8.
(22) Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003; 138(5):490-5; discussion 495-7.
(23) Ellis FH Jr, Crozier RE, Gibb SP. Reoperative achalasia surgery. J Thorac Cardiovasc Surg 1986; 92(5):859-65. Erratum in: J Thorac Cardiovasc Surg 1987; 93(4):559.
(24) Malthaner RA, Tood TR, Miller L, Pearson FG. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg 1994; 58(5):1343-6; discussion 1346-7.
(25) Dor J, Humbert P, Dor V, Figarella J. L'interet de la technique de Nissen modifiee dans la prevention de reflux apres cardiomyotomie extramuqueuse de Heller. Mem Acad Chir (Paris) 1962; 88:877-83.
(26) Bonavina L, Nosadini A, Bardini R, Baessato M, Peracchia A. Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. Arch Surg 1992; 127(2):222-6.
(27) Zhu ZJ, Chen LQ, Duranceau A. Long-term result of total versus partial fundoplication after esophagomyotomy for primary esophageal motor disorders. World J Surg 2008; 32(3):401-7.
(28) Donahue PE, Schlesinger PK, Sluss KF, Richter HM, Liu KJ, Rypins EB, et al. Esophagocardiomyotomy-floppy Nissen fundoplication effectively treats achalasia without causing esophageal obstruction. Surgery 1994; 116(4):719-24.
(29) Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor undoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 2008; 248(6):1023-30.
(30) Orringer MB, Stirling MC. Esophageal resection for achalasia: indications and results. Ann Thorac Surg 1989; 47(3):340-5.
(31) Pinotti HW, Cecconello I, da Rocha JM, Zilberstein B. Resection for achalasia of the esophagus. Hepatogastroenterology 1991; 38(6):470-3.
(32) Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 1999; 230(4):587-93.
(33) Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 2008; 12(1):159-65.
Publicado
2013-03-31
Cómo citar
1.
Rodríguez Temesio G, González González D, Ruso L. Tratamiento laparoscópico de la acalasia en un centro de baja frecuencia. Rev. Méd. Urug. [Internet]. 31 de marzo de 2013 [citado 16 de abril de 2024];29(1):26-2. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/296
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