title: Minimally invasive surgical treatment of sigmoidal esophagus in achalasia.
abstract: BACKGROUND
  The appropriate surgical intervention for sigmoidal esophagus in the setting of achalasia remains controversial. The objective of this study is to review our experience with minimally invasive myotomy (MIM) and minimally invasive esophagectomy (MIE) in the treatment of these patients.
  
  
  METHODS
  We reviewed the records of 30 patients (19 men, 11 women); mean age 59.1 years (range 25-83 years) who underwent MIM (n = 24) or MIE (n = 6). Primary variables included perioperative and long-term outcomes. Univariate and multivariate analyses were performed to identify clinical variables predictive of myotomy failure.
  
  
  RESULTS
  The operative mortality was zero and median hospital stay was 2 days (MIM) and 7 days (MIE). On follow-up (mean 30.5 months), nine (37.5%) patients undergoing primary MIM had failure requiring redo myotomy (n = 1) or esophagectomy (n = 8). Univariate analysis showed that previous myotomy and duration of symptoms were significant predictors of failure of MIM, with patient age trending toward significance. Multivariate analysis showed age and longer symptom duration to be significant.
  
  
  CONCLUSIONS
  MIM affords symptomatic improvement in many patients. Age and symptom duration may be preoperative indicators of MIM failure. MIE offers similar symptom relief but is associated with a longer hospital stay. Further prospective studies are required to define the optimum treatment algorithm in the management of these patients.
authors.affiliation: Division of Thoracic and Foregut Surgery, Heart, Lung and Esophageal Surgery Institute, UPMC Health System, Shadyside Medical Building, Suite 715, 5200 Centre Avenue, Pittsburgh, PA 15232, USA. schuchertmj@upmc.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Schuchert
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Arman
authors.initials: A
authors.lastname: Kilic
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Miguel
authors.initials: M
authors.lastname: Alvelo-Rivera
authors.forename: Neil A
authors.initials: NA
authors.lastname: Christie
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gilbert
authors.forename: Arjun
authors.initials: A
authors.lastname: Pennathur