Excellent outcomes of laparoscopic esophagomyotomy for achalasia in patients older than 60 years of age

The effectiveness of an esophagomyotomy for dysphagia in elderly patients with achalasia has been questioned. This study was designed to provide an answer. A total of 162 consecutive patients with achalasia who had a laparoscopic myotomy and Dor fundoplication and who were available for follow-up interview were divided by age: <60 years (range, 14–59; 118 patients), and ≥60 years (range, 60–93; 44 patients). Primary outcome measures were severity of dysphagia, regurgitation, heartburn, and chest pain before and after the operation as assessed on a four-point Likert scale, and the need for postoperative dilatation or revisional surgery. Follow-up averaged 64 months. Older patients had less dysphagia (mean score 3.6 vs. 3.9; P < 0.01) and less chest pain (1.0 vs. 1.8; P < 0.01). Regurgitation (3.0 vs. 3.2; P = not significant (NS)) and heartburn (1.6 vs. 2.0, P = NS) were similar. Older patients were no different in degree of esophageal dilation, manometric findings, number of previous pneumatic dilatations, or previous botulinum toxin therapy. None of the older patients had previously had an esophagomyotomy, whereas 14% of younger patients had (P < 0.01). After laparoscopic myotomy, older patients had better relief of dysphagia (mean score 1.0 vs 1.6; P < 0.01), less heartburn (0.8 vs. 1.1; P = 0.03), and less chest pain (0.2 vs. 0.8, P < 0.01). Complication rates were similar. Older patients did not require more postoperative dilatations (22 patients vs. 10 patients; P = 0.7) or revisional surgery for recurrent or persistent symptoms (3 vs. 1 patients; P = 0.6). Satisfaction scores did not differ, and more than 90% of patients in both groups said in retrospect they would have undergone the procedure if they had known beforehand how it would turn out. This retrospective review with long follow-up supports laparoscopic esophagomyotomy as first-line therapy in older patients with achalasia. They appeared to benefit even more than younger patients

Scarless outpatient ablation of pilonidal sinus: a pilot study of a new minimally invasive treatment.

Pain and secretion of purulent materials are symptoms that are often associated with the pilonidal sinus. Generally, these symptoms are neglected by patients for a long time. Patients seek medical attention too late, fearing a prolonged period of pain and inability after surgery. The optimal therapy for pilonidal sinus should have the following characteristics: high healing rate, low recurrence rate, minimal postoperative pain and low cost. The aim of this study is to explore the effectiveness and safety of a new minimally invasive treatment: the scarless outpatient ablation of pilonidal sinus (SOAP). A total of 31 consecutive patients were enrolled; 27 of 31 patients were declared healed after the surgery (87·09%). After 1 year, only 4 of 27 patients (14·81%) reported symptoms related to recurrence of the disease. The average duration of the operation was 7·47 minutes. Patients reported the disappearance of painful symptoms after approximately 2·62 days and had been away from work for 0·53 days. No complications were recorded during the period of study. The advantages of the procedure examined in this study are its simplicity and rapidity of execution, its outpatient setting, its low cost and lack of complications. In our opinion, a randomised controlled trial should be conducted to validate the results related to this technique