Laparoscopic myotomy for oesophageal achalasia - adding an antireflux procedure is not always necessary

Laparoscopy is the access of choice for functional surgery of the gastroesophageal junction, and oesophagocardiomyotomy, as the conventional surgical treatment of achalasia, is one of the favourable indications for laparoscopic surgery. Laparoscopic anterior myotomy technique is highly effective and secure for relieving dysphagia with minimal risk of gastroesophageal reflux. Fifteen patients with the diagnosis of achalasia were treated with laparoscopic anterior face oesophagocardiomyotomy without a concomitant antireflux procedure. There was not any peri-operative complication and no procedure was converted to open operation. Oesophageal cineradiography, manometry and 24-h pH monitoring were repeated postoperatively. Manometry showed a significant reduction of the resting tone (48-34.4 to 18-3.2 mmHg), and patients were free of symptoms for reflux and dysphagia at the follow-up between 8 and 96 (median 42) months. Only one patient needed pneumatic dilation, 1 year after the operation for mild dysphagia, and one patient had moderate reflux, which was managed by medication. Thanks to minimal invasive technique of laparoscopic surgery and intraoperative endoscopy, oesophagocardiomyotomy can safely be performed in a length needed without dividing lateral and posterior phrenoesophageal ligamentous attachments. Consequently, adding an antireflux procedure routinely is not necessary. We advocate laparoscopic anterior oesophagocardiomyotomy alone as the first-line treatment for achalasia. (C) 2004 Blackwell Publishing Ltd

Laparoscopic esophagomyotomy without an antireflux procedure for the treatment of achalasia

Various gastroenteric surgical procedures have been attempted laparoscopically. Laparoscopic esophagomyotomy (LE) with or without fundoplication, performed for achalasia, has gained popularity. In our clinic, LE (Heller's myotomy) was performed on six patients with achalasia. All patients underwent barium esophagography, endoscopy, and esophageal manometry for diagnosis. Extramucosal myotomy was started 6 cm above the cardioesophageal junction on the left anterolateral aspect of the esophagus and continued 1 cm below this area. Endoscopic control of the distal esophageal mucosa and the stomach was carried out under direct laparoscopic visualization following the completion of myotomy during the operation. EE was completed without complication in five patients. In one patient (16%), mucosal perforation occurred after myotomy during endoscopic control and was repaired with endostitches. These were no postoperative complications. The average hospital stay was 3 days. Three of the six patients agreed to 24-h pH monitoring, the results of which showed no evidence of reflux. All patients were completely symptom free in the postoperative period. The average preoperative lower esophageal sphincter pressure was 44 mm Hg, whereas in the early postoperative period and 6 months later, it was II mm Hg. There was no dysphagia or reflux esophagitis during the follow-up period (range 12 to 24 months). LE is associated with low morbidity and a high success rate, comparable with an open procedure, and can be done without an antireflux procedure

The Fourier Transform Infrared (Ftir) Spectroscopic and Mass Spectrometric Metabolomics Studies of Ankaferd Hemostat

Ankaferd is a traditional folkloric medicine that has been used in Anatolia as a hemostatic agent for centuries. Ankaferd Blood Stopper (ABS) is comprised of a standardized plant extracts of T. vulgaris, G. glabra, V. vinifera, A.officinarum and U. Dioica. ABS modulates cellular apoptotic responses to hemorrhagic stress, as well as the hemostatic hemodynamic activity. Although the effects of ABS mainly depends upon the formation of an encapsulated protein network representing focal points for vital erythrocyte aggregation, integration of the functional proteomics, transcriptomics, and metabolomics will be important for detecting the exact 'mechanism-of-action' of ABS. In order to analyse the fourier transform infrared (FTIR) spectroscopic and mass spectrometric metabolomics, we prepared two-dimensional protein samples and used a Tensor 27 FTIR spectrometer, equipped with a high throughput extension (HTS-XT) accessory. The derivative spectra of metabolomic content of ABS and mass spectrometric and FTIR results were demonstrated. Biological fatty acids such as octanoic acid, heptanoic acid, decanoic acid, eicosanoic acid, octadecanoic acid, hexadecanoic acid, and others have been detected in the metabolomics of ABS. Our results about mass spectrometry and FTIR spectroscopy analyses ABS content within the many crossroads of hemostasis, infection, and neoplasia. Metabolomics studies may shed further light and represent a novel starting point on that perspective for the new avenues of ABS.WoSScopu