Clinical and pathophysiological outcomes of the robotic-assisted Heller –Dor myotomy for achalasia: a single-center experience

AbstractLaparoscopic Heller myotomy and Dor fundoplication is considered a safe and effective treatment for achalasia. Robotic-assisted Heller –Dor procedure (RAHD) has emerged as an alternative approach due to improved visualization and fine motor control. The aim of this prospective study was to evaluate clinical, and functional results of RAHD. We evaluated a group of 66 patients with achalasia that underwent robotic-assisted Heller– Dor operation. Before treatment all patients underwent a diagnostic work-up such as upper endoscopy, esophageal barium swallow and high resolution manometry. The presence of postoperative gastroesophageal reflux disease was diagnosed by impedance and pH monitoring (MII-pH). Dysphagia improved in 92. 4% of patients after treatment. Barium swallow series showed esophageal emptying in 100% of patients and a significant reduction of the esophageal diameter (p  =  0.00235). Forty-five of 66 patients (68.2%) underwent upper endoscopy and 35 of 66 (53%) underwent MII-pH. Esophageal erosions were found in 4/45 (8,8%) and MII-pH showed abnormal results in 3/35 patients (8.6%). RAHD ensures a meticulous esophageal and gastric myotomy, allowing to visualize and divide each muscle fibers with a low rate of intraoperative and postoperative complications. resulting in turn in good clinical outcomes, radiological findings and functional results even if robotic tecnique definitely increases the surgical cost in the treatment of ...
Source: Journal of Robotic Surgery - Category: Surgery Source Type: research

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A 78-year-old female with chronic gastroesophageal reflux disease presented to the primary care office for evaluation of dyspepsia and dysphagia. Upper endoscopy revealed a partially obstructing submucosal tumor 15cm from the incisors. Endoscopic ultrasound (EUS) examined a 2cm heterogenous and multicystic mass in the submucosa. The patient was referred for endoscopic resection.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Saturday abstract Source Type: research
CONCLUSION Male gender and hiatal hernia were associated with EE. Aged patients, smoking and hiatal herni a were related to severe EE. It is suggested that the risk factors for EE and non-EE types are different. Cohort studies are necessary to identify the exact mechanisms involved in each disease form.RESUMO CONTEXTO: A doen ça do refluxo gastroesofágico (DRGE) é uma das doenças digestivas mais comuns na prática médica e deve ser suspeitada de acordo com os seus sintomas clínicos, podendo ser classificada em esofagite erosiva (EE) de acordo com os achados de endoscopia. OBJ...
Source: Arquivos de Gastroenterologia - Category: Gastroenterology Source Type: research
ConclusionThe majority of patients undergoing ARS do not require additional care within 90  days of surgery. Patients who are readmitted accrue costs that almost double the overall cost of care compared to the initial hospitalization. Measures to attenuate potentially preventable readmissions after ARS may reduce healthcare utilization in this patient population.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
Conclusions: A duodenal biopsy is more likely to be performed in younger patients, females, and for key indications such as weight loss, diarrhea, and anemia. Providers varied widely in the performance of duodenal biopsy. Further study is warranted to better understand the decision to perform duodenal biopsy and to determine the optimal scenarios for its performance.
Source: Journal of Clinical Gastroenterology - Category: Gastroenterology Tags: ONLINE ARTICLES: Original Articles Source Type: research
Eosinophilic esophagitis in pediatric age, state of the art and review of the literature. Acta Biomed. 2018 Dec 17;89(8-S):20-26 Authors: Iuliano S, Minelli R, Vincenzi F, Gaiani F, Ruberto C, Leandro G, Bizzarri B, Nouvenne A, Di Mario F, De'Angelis GL Abstract Eosinophilic esophagitis (EoE) is a chronic immune-mediated relapsing disease caused by eosinophilic infiltration of the esophageal mucosa which is normally lacking these cells. EoE belongs to the group of the so called Eosinophilic Gastrointestinal Disorders (EGIDs). From a rare and unusual disease, EoE has become an emerging entity and ...
Source: Acta Bio-Medica : Atenei Parmensis - Category: General Medicine Authors: Tags: Acta Biomed Source Type: research
Conclusion: We suggest that HBT should be considered in the clinical management of patients with suspected FD. In cases of positive HBTs, a potential causal therapy can be initiated.Digestion
Source: Digestion - Category: Gastroenterology Source Type: research
Background: Currently, the advantages of pre-operative upper endoscopy in patients undergoing weight loss surgery remains controversial. Data suggests that patients with obesity have a high incidence of gastro-oesophageal reflux, oesophagitis and hiatus hernia (HH). Upper endoscopy findings may play an important role in operative planning. Currently, little evidence exists regarding the diagnostic sensitivity of upper endoscopy in detecting hiatus hernia.
Source: Surgery for Obesity and Related Diseases - Category: Surgery Authors: Source Type: research
Conclusion Routine endoscopy seems to play an important part in the preoperative preparation of patients planned for bariatric surgery in the Middle East population. Further studies or meta-analysis could help in building up clear solid evidence and guidelines that could be approved by international bariatric associations with regard to indications for preoperative upper endoscopy in bariatric patients. [...] © Georg Thieme Verlag KG Stuttgart · New YorkArticle in Thieme eJournals: Table of contents  |  Abstract  |  open access Full text
Source: Endoscopy International Open - Category: Gastroenterology Authors: Tags: Original article Source Type: research
Abstract PURPOSE: Patients with gastroesophageal reflux disease without esophagitis show varying responses to proton pump inhibitors (PPIs). The aim of this study was to objectively evaluate the effect of a new PPI, ilaprazole, on patients with heartburn but without reflux esophagitis. MATERIALS AND METHODS: This prospective study was performed on 20 patients with heartburn but without reflux esophagitis. All patients underwent upper endoscopy and 24-hr combined multichannel intraluminal impedance and pH esophageal monitoring (MII-pH). They were then treated with ilaprazole (20 mg) once daily for 4 weeks. The...
Source: Yonsei Medical Journal - Category: Universities & Medical Training Authors: Tags: Yonsei Med J Source Type: research
This study also illustrates the importance of PPI therapy in LPR patients with no evidence of GERD.
Source: Indian Journal of Otolaryngology and Head and Neck Surgery - Category: ENT & OMF Source Type: research
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