title: Impact of esophageal flexion level on the surgical outcome in patients with sigmoid esophageal achalasia.
abstract: OBJECTIVE
  Esophageal achalasia can be roughly divided into non-sigmoid and sigmoid types. Laparoscopic surgery has been reported to be less than optimally effective for sigmoid type. The aim of this study was to examine the impact of the esophageal flexion level on the clinical condition and surgical outcomes of patients with sigmoid esophageal achalasia.
  
  
  METHODS
  The subjects were 36 patients with sigmoid esophageal achalasia who had been observed for >1 year after surgery. The subjects were divided into sigmoid type (Sg) and advanced sigmoid type (aSg) groups based on the flexion level of the lower esophagus to compare their clinical parameters and surgical outcomes.
  
  
  RESULTS
  The Sg and aSg groups included 26 (72%) and 10 subjects, respectively. There were no marked differences in the clinical parameters or surgical outcomes between the two groups. However, the clearance rate calculated using the timed barium esophagogram was lower in the aSg group than in the Sg group. No differences were found in the postoperative symptom scores between the two groups, and both reported a high level of satisfaction.
  
  
  CONCLUSIONS
  Although laparoscopic surgery for symptoms of sigmoid esophageal achalasia was highly successful regardless of the flexion level, the improvement in esophageal clearance was lower when the flexion level was higher.
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan. kazuto@jikei.ac.jp.
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsuboi
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Omura
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Yano
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Hoshino
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Se-Ryung
authors.initials: SR
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Akimoto
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Masuda
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Kashiwagi
authors.affiliation: Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Yanaga
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000145:classification / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D018583:Pliability; D016896:Treatment Outcome
keywords: Esophageal achalasia; Flexion level; Sigmoid type; Surgical outcome