achalasia cardia 2003
DESCRIPTION
TRANSCRIPT
Department of Paediatric SurgerySri Ramachandra Medical College & RI
Porur, Chennai- 600116
Dr.R.M.Manoj kumar Dr .Deepak J.
Dr.P.Balamourougane Dr. R.Madhu
Dr. Prakash AgarwalProf. S.Balagopal
History
6 months /maleC/o feeding difficultyH/o vomiting immediately after taking feedsRecurrent respiratory tract infectionLoss of weightInvestigated outside
Examination
Weight 4 kgsVitals stableCvs: s1 s2 +Rs: bilateral air entry+, mild creps+P/A: soft,Bs+,no organomegaly no mass palpable
Investigation
Blood R/E: normalUrine R/E: normalRFT and Sr.Electrolytes: normalCoagulation profile: Normal
X ray chest
Pneumonic patch - ? aspiration
Barium swallow
Rat tail apperanance+
Diagnosis
Achalasia cardia
Procedure
Laparoscopic cardiomyotomy with Dor’s fundoplication
Position
Supine and cross table
24 F feeding tube inserted
Ports
Five 5mm ports -Umbilical –
camera -Hypogastric –
stomach retraction -Epigastric – liver retraction - Right and left
lumbar
Procedure
Post op
UneventfulStarted on feed on
day3No vomiting and
tolerated feeds wellDischarged on day5Sutures removed on
day 10
Follow up
Taking feeds wellWeight gain +
Conclusion
Advantages No scar Less morbidity Early recovery Shorter hospital stay Decreased period of immobility Shorter time to tolerating oral diet
Conclusion
Achalasia cardia is rare in infantsLaparoscopic cardiomyotomy in infant is
more demanding
References
Laparoscopic cardiomyotomy with anterior partial fundoplication achieves excellent symptomatic relief for patients with achalasia, and it can be performed with minimal morbidity
Angkoolpakdeekul, Theerapol (T); Jakapark, Suriya (S); Journal of the Medical Association
of Thailand,Chotmaihet thangphaet (J Med Assoc Thai), 2007-May; vol 90 (issue 5) : pp
988-93.
ReferencesThe advent of laparoscopic cardiomyotomy,
performed through five small cuts on the abdominal wall and the added promise of long-term relief of dysphagia, has resurrected the role of surgery in the treatment of achalasia.
Laparoscopic cardiomyotomy has now become the treatment of choice for achalasia cardia all around the globe.
Laparoscopic treatment of Achalasia Cardia-S Sadhu, S Sarkar, J K Shah, S K Dubey, M
K Roy, Dept. of Surgery & MIS Healing TouchVol-3 No. 11December, 2005
References
1. Sweet MP, N. I., Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG. (2008). "The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation." J Gastrointest Surg. 12: 159-165.2. Jafri M, A. M., Kaul A, Dierig J, Racadio J, Inge T, Brown R, Ryckman F, Tiao G. (2008). "Intraoperative manometry during laparoscopic Heller myotomy improves outcome in pediatric achalasia." J Pediatr Surg. 43: 66-70.3. Lake JM, W. R. (2006). "Review article: the management of achalasia - a comparison of different treatment modalities." Aliment Pharmacol Ther. 24: 909-18.4. Ahmed., A. (2008). "Achalasia: what is the best treatment?" Ann Afr Med. 7: 141-8.5. Palanivelu C, M. G., Jani K, Parthasarthi R, Sendhilkumar K, Rangarajan M. (2007). "Minimally invasive management of achalasia cardia: results from a single center study." JSLS. 11: 350-7.6. Nomura T, M. M., Makino H, Okawa K, Iwakiri K, Tajiri T. (2008). "Usefulness of the laparoscopic Heller-Dor operation for esophageal achalasia: introducing the procedure to our institution." J Nippon Med Sch. 75: 207-11.7. Avtan L, A. C., Guvenc H, Igci A, Ozmen V (2005). "Laparoscopic myotomy for oesophageal achalasia--adding an antireflux procedure is not always necessary." Int J Clin Pract.59:35-8.8. Wang QS, L. L., Dong L, Shen ZL, Zhou DH, Hu CX. (2006). "Laparoscopic Heller-Dor operation for patients with achalasia." Chin Med J (Engl). 119: 443-7.9. Esposito C, M.-S. M., Roblot Maigret B, Amici G, Desruelle P, Montupet P. (2000). "Complications of laparoscopic treatment of esophageal achalasia in children." J Pediatr Surg. 35: 680-3.
Thank you