Efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasia
Abstract To investigate the safety and short-term effectiveness of laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction for the treatment of terminal or end-stage achalasia, patients with end-stage achalasia treated with laparoscopic-assisted cardiectomy with side-overl...
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Nature Portfolio
2025-01-01
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| Online Access: | https://doi.org/10.1038/s41598-024-74143-8 |
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| author | Jing-Tao Wang Yu-Xiang Sun Rui-Xin Li Yun-Fei Zhang Heng-Xuan Ding Guo-Jun Wang Bu-Lang Gao |
| author_facet | Jing-Tao Wang Yu-Xiang Sun Rui-Xin Li Yun-Fei Zhang Heng-Xuan Ding Guo-Jun Wang Bu-Lang Gao |
| author_sort | Jing-Tao Wang |
| collection | DOAJ |
| description | Abstract To investigate the safety and short-term effectiveness of laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction for the treatment of terminal or end-stage achalasia, patients with end-stage achalasia treated with laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction were retrospectively enrolled. The clinical data, surgical data and follow-up were analyzed. Among twenty-five patients enrolled, the achalasia type St was present in 12 (48%) patients, type Sg in 9 (36%), and type aSg in 4 (16%). The surgical time ranged 60–180 min (median 100 min) with an intraoperative blood loss 20-200 ml (median 50 ml). Five (20%) patients experienced complications within a week after surgery, with fever (> 38.5 ℃) in two (40%) patients within 3 days after surgery, abdominal incision infection in one (20%), and anastomotic leak in two (40%). The postoperative hospitalization time ranged 8–44 (median 10) days. Follow-up was conducted 6–38 months (median 16) after surgery. Compared with the preoperative Eckardt score (7.64 ± 1.32), the Eckardt score was significantly (P < 0.01) decreased at one month (0.52 ± 0.87), 6 (0.84 ± 1.11) and 12 (1.23 ± 1.23) months after surgery in all patients. The Eckardt score in type St was significantly (P < 0.05) smaller than in type Sg or aSg at 6 and 12 months after surgery. Seven patients maintained an Eckardt score 0 with complete relief of their symptoms. The effective rate was 100% for type St, 88.8% for type Sg, and 75% for type aSg. The effective rates at 1 month, 6 and 12 months after surgery were 100% (95% CI: 100% -100%), 96% (95% CI: 87.7 -100%), and 92% (95% CI: 80.6 -100%). Two patients were diagnosed with gastroesophageal reflux disease (GERD) at the end of the follow-up. The cumulative incidence of GERD at 1 month, 6 and 12 months after surgery was 0, 4% (95% confidence interval or CI: 0-12.3%), and 8% (95% CI: 0-19.4%). In conclusion, the laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction is safe and effective for the treatment of end-stage achalasia, and the effect is significantly better for achalasia type St than for types Sg and aSg. |
| format | Article |
| id | doaj-art-9868ca8f593e4b268760e66e4384e45a |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-9868ca8f593e4b268760e66e4384e45a2025-01-12T12:24:14ZengNature PortfolioScientific Reports2045-23222025-01-0115111010.1038/s41598-024-74143-8Efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasiaJing-Tao Wang0Yu-Xiang Sun1Rui-Xin Li2Yun-Fei Zhang3Heng-Xuan Ding4Guo-Jun Wang5Bu-Lang Gao6Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou UniversityDepartment of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou UniversityAbstract To investigate the safety and short-term effectiveness of laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction for the treatment of terminal or end-stage achalasia, patients with end-stage achalasia treated with laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction were retrospectively enrolled. The clinical data, surgical data and follow-up were analyzed. Among twenty-five patients enrolled, the achalasia type St was present in 12 (48%) patients, type Sg in 9 (36%), and type aSg in 4 (16%). The surgical time ranged 60–180 min (median 100 min) with an intraoperative blood loss 20-200 ml (median 50 ml). Five (20%) patients experienced complications within a week after surgery, with fever (> 38.5 ℃) in two (40%) patients within 3 days after surgery, abdominal incision infection in one (20%), and anastomotic leak in two (40%). The postoperative hospitalization time ranged 8–44 (median 10) days. Follow-up was conducted 6–38 months (median 16) after surgery. Compared with the preoperative Eckardt score (7.64 ± 1.32), the Eckardt score was significantly (P < 0.01) decreased at one month (0.52 ± 0.87), 6 (0.84 ± 1.11) and 12 (1.23 ± 1.23) months after surgery in all patients. The Eckardt score in type St was significantly (P < 0.05) smaller than in type Sg or aSg at 6 and 12 months after surgery. Seven patients maintained an Eckardt score 0 with complete relief of their symptoms. The effective rate was 100% for type St, 88.8% for type Sg, and 75% for type aSg. The effective rates at 1 month, 6 and 12 months after surgery were 100% (95% CI: 100% -100%), 96% (95% CI: 87.7 -100%), and 92% (95% CI: 80.6 -100%). Two patients were diagnosed with gastroesophageal reflux disease (GERD) at the end of the follow-up. The cumulative incidence of GERD at 1 month, 6 and 12 months after surgery was 0, 4% (95% confidence interval or CI: 0-12.3%), and 8% (95% CI: 0-19.4%). In conclusion, the laparoscopic-assisted cardiectomy with side-overlap esophagogastric reconstruction is safe and effective for the treatment of end-stage achalasia, and the effect is significantly better for achalasia type St than for types Sg and aSg.https://doi.org/10.1038/s41598-024-74143-8Laparoscopic-assisted cardiectomySide-overlap esophagogastric reconstructionAchalasiaEnd stageEffectiveness |
| spellingShingle | Jing-Tao Wang Yu-Xiang Sun Rui-Xin Li Yun-Fei Zhang Heng-Xuan Ding Guo-Jun Wang Bu-Lang Gao Efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasia Scientific Reports Laparoscopic-assisted cardiectomy Side-overlap esophagogastric reconstruction Achalasia End stage Effectiveness |
| title | Efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasia |
| title_full | Efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasia |
| title_fullStr | Efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasia |
| title_full_unstemmed | Efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasia |
| title_short | Efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasia |
| title_sort | efficacy of laparoscopic cardiectomy combined with side overlap anastomosis for the treatment of terminal achalasia |
| topic | Laparoscopic-assisted cardiectomy Side-overlap esophagogastric reconstruction Achalasia End stage Effectiveness |
| url | https://doi.org/10.1038/s41598-024-74143-8 |
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