Impact of minimally invasive surgery on the treatment of XXXX : a decade of change.

@entity1 @entity384 @entity1318 @entity1282
BACKGROUND: Twenty years ago an average of 1.5 Heller myotomies were performed per year in our hospital, mostly for @entity1 whose @entity1282 did not improve following @entity384 or whose esophagus had been perforated during a @entity384 . Ten years ago we started using minimally invasive surgery to treat this disease. STUDY DESIGN: This study measures the impact of minimally invasive surgery with regard to the following: the number of @entity1 referred for treatment; the number of @entity1 who came to surgery without previous treatment; and the results of surgical treatment. Between 1991 and 2001, 149 @entity1 had minimally invasive surgery for @entity1318 : 25 @entity1 (17%) had thoracoscopic Heller myotomy and 124 (84%) had laparoscopic Heller myotomy and Dor fundoplication. Of the 149 @entity1 , 79 @entity1 (53%) had previous treatment (56 @entity1 [71%], @entity384 ; 7 @entity1 [9%], botulinum toxin injection; 16 @entity1 [20%], both) and 70 @entity1 (43%) had none of these treatments. Mean postoperative followup was 59 +/- 36 months. @entity1 were divided into two groups: group A, operated on between 1991 and 1995; and group B, operated on between 1996 and 2001. RESULTS: In the past decade, the number of @entity1 referred for surgery has increased substantially--group A, 48; group B, 101; an increasing proportion of @entity1 were referred for surgery without previous treatment--group A, 38%; group B, 51%; and the outcomes of the operation progressively improved--group A, 87%; group B, 95%. CONCLUSIONS: These data show that the high success rate of laparoscopic Heller myotomy for @entity1318 has brought a shift in practice; surgery has become the preferred treatment of most gastroenterologists and other referring physicians. This has followed documentation that laparoscopic treatment outperforms @entity384 and botulinum toxin injection.
