SHORT AND LONG TERM RESULTS OF THE LAPAROSCOPIC HELLER-DOR MYOTOMY. THE INFLUENCE OF AGE AND PREVIOUS CONSERVATIVE THERAPIES

Analisi dei risultati della terapia chirurgica dell'acalasia esofagea con tecnica di Heller-Dor laparoscopica in pazienti anziani con e senza dilatazione pneumatica pregress

Should Surgery Replace Pneumatic Dilation in Achalasia? Reply.

As surgeons dedicated to the repair of upper and lower gastrointestinal tract dysfunction, the main goal of our paper was to evaluate the influence of 2 different conditions on the surgical treatment of patients suffering from achalasia, referred to our outpatient endoscopy service. Historically, both patient age and previous nonsurgical treatments were regarded in the literature as relative contraindications to surgery. Our results did not support these contentions, provided that patients fulfilled the accepted criteria for a surgical procedure. As far as cost effectiveness is concerned (Surg Endosc 2007;21:1184–1189), it seems that the comparison has been done between surgery and a single procedure (pneumatic dilation), but it is accepted that dilation often needs to be repeated 2–3 times to achieve a 90% short-term success rate, which decreases to fewer than half the patients at 5 years follow-up (Am J Gastroenterol 2002;97:1346). The literature suggests that these patients mandate a median of 2 (range, 1–8) sessions of endoscopic dilations (Ann Surg 2002;236:750–758), which could certainly impact the quality of life of these patients. The therapy of achalasia, whether surgical or endoscopic, should be regarded as palliative and consequently a long-term successful outcome after surgery in nearly 80% of our patients seems to be satisfying. Nevertheless, I suggest that it is best to avoid the potential to be caught in the trap of voicing the best option between the 2 very effective therapeutic options. I would like to stress that we perform surgery as well pneumatic dilation with Rigiflex balloons, but based on published literature and the analysis of our patients, I am more confident that dilation, if unsuccessful, will not alter the outcome of a subsequent myotomy

THE OUTCOME OF LAPAROSCOPIC COLORECTAL SURGERY IN ELDERLY PATIENTS: OUR EXPERIENCE.

The preliminary experience of surgical treatment of colo-rectal cancer in patients older than 65 years by laparoscopic approach is referred, looking at early and middle term outcome. the conclusion is that age does not influence the choice of surgical approach as far as laparoscopic outcome is safe andallows better results in terms of morbidity and hospitalisation