Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis
- Journal Title
- Langenbeck's Archives of Surgery
- Publication Type
- Review
- Abstract
- PURPOSE: Synchronous and metachronous presentations of achalasia and obesity are increasingly common. There is limited data to guide the combined or staged surgical approaches to these conditions. METHODS: A systematic review (MEDLINE, Embase, and Web of Science) and patient-level meta-analysis of published cases were performed to examine the most effective surgical approach for patients with synchronous or metachronous presentations of achalasia and obesity. RESULTS: Thirty-three studies with 93 patients were reviewed. Eighteen patients underwent concurrent achalasia and bariatric surgery, with the most common (n = 12, 72.2%) being laparoscopic Heller's myotomy (LHM) and Roux-en-Y gastric bypass (RYGB). This combination achieved 68.9% excess weight loss and 100% remission of achalasia (mean follow-up: 3 years). Seven (6 RYGB, 1 biliopancreatic diversion) patients had bariatric surgery following achalasia surgery. Of these, all 6 RYGBs had satisfactory bariatric outcomes, with complete remission of their achalasia (mean follow-up: 1.8 years). Sixty-eight patients underwent myotomy following bariatric surgery; the majority (n = 55, 80.9%) were following RYGB. In this scenario, per-oral endoscopic myotomy (POEM) achieved higher treatment success than LHM (n = 33 of 35, 94.3% vs. n = 14 of 20, 70.0%, p = 0.021). Moreover, conversion to RYGB following a restrictive bariatric procedure during achalasia surgery was also associated with higher achalasia treatment success. CONCLUSION: In patients with concurrent achalasia and obesity, LHM and RYGB achieved good outcomes for both pathologies. For those with weight gain post-achalasia surgery, RYGB provided satisfactory weight loss, without adversely affecting achalasia symptoms. For those with achalasia after bariatric surgery, POEM and conversion to RYGB produced greater treatment success.
- Publisher
- Springer Nature
- Keywords
- Humans; *Esophageal Achalasia/surgery; Obesity/complications/surgery; *Gastric Bypass/adverse effects; Treatment Outcome; *Laparoscopy/methods; Weight Loss
- Department(s)
- Surgical Oncology
- PubMed ID
- 37843694
- Publisher's Version
- https://doi.org/10.1007/s00423-023-03143-5
- Open Access at Publisher's Site
https://doi.org/10.1007/s00423-023-03143-5- Terms of Use/Rights Notice
- Refer to copyright notice on published article.
Creation Date: 2023-12-05 12:35:28
Last Modified: 2023-12-05 12:50:03