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Title: Surgical approaches for achalasia and obesity: a systematic review and patient-level meta-analysis.
Austin Authors: Kunz, Stephen A ;Ashraf, Hamza;Klonis, Christopher;Thompson, Sarah K;Aly, Ahmad ;Liu, David Shi Hao 
Affiliation: Surgery (University of Melbourne)
Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 5042, Australia.
General and Gastrointestinal Surgery Research and Trials Group, Department of Surgery, Austin Precinct, Austin Health, The University of Melbourne, 145 Studley Road, Heidelberg, Victoria, 3084, Australia.;Division of Cancer Surgery, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.
Issue Date: 16-Oct-2023
Date: 2023
Publication information: Langenbeck's Archives of Surgery 2023-10-16; 408(1)
Abstract: 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. 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. 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. 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.
DOI: 10.1007/s00423-023-03143-5
Journal: Langenbeck's Archives of Surgery
Start page: 403
PubMed URL: 37843694
ISSN: 1435-2451
Type: Journal Article
Subjects: Achalasia
Bariatric surgery
Eckardt score
Appears in Collections:Journal articles

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