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    Clinical Outcomes of Standard vs. Extended Heller Myotomy with Nissen and Dor Fundoplication: A Comprehensive Study in the Surgical Management of Achalasia
    (Springer Science and Business Media LLC, 2025-01-25) Fahri Yetişir; Muhammet Emin Çelik; Yunus Emre Taşkın; Ömer Kurt; Ramazan Tiken
    Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter and loss of peristalsis. Laparoscopic Heller myotomy (LHM) combined with anti-reflux surgery is considered the gold standard for long-term treatment. However, there is ongoing debate regarding the optimal myotomy length and choice of anti-reflux procedure. This retrospective study analyzed 49 achalasia patients treated between 2016 and 2023 using two Heller myotomy techniques (standard vs. extended) combined with two anti-reflux procedures (Nissen vs. Dor fundoplication). Data on demographic characteristics, surgical details, complications, and postoperative outcomes were collected. Patients were followed up to assess dysphagia, Gastroesophageal reflux disease (GERD) symptoms, recurrence rates, and satisfaction levels. Extended myotomy significantly reduced recurrence rates compared to standard myotomy (0% vs. 22.2%, p = 0.014). Nissen fundoplication was associated with fewer GERD symptoms than Dor fundoplication (p = 0.01). Patient satisfaction was highest in the extended myotomy with the Nissen fundoplication group (p = 0.009). No mortality occurred, and complications were minimal. Postoperative timed water-soluble contrast esophagograms showed effective esophageal emptying in 91.8% of patients. Relapse cases were successfully managed with additional interventions. Extended myotomy with Nissen fundoplication provides superior outcomes in achalasia treatment, including lower recurrence rates, fewer GERD symptoms, and higher patient satisfaction. These findings highlight the importance of myotomy length and anti-reflux procedure selection for optimizing treatment outcomes. Further studies are needed to validate these results and establish standardized protocols.
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    Laparoscopic Duodenojejunostomy for the Treatment of Superior Mesenteric Artery Syndrome: Analysis of 91 Patients
    (Springer Science and Business Media LLC, 2025-02-14) Fahri Yetişir; Muhammet Emin Çelik; Yunus Emre Taşkın; Oguzhan Özdemir; Ömer Kurt; Ramazan Tiken; Osman Yüksel
    Superior mesenteric artery syndrome (SMAS) is a rare condition caused by the compression of the third portion of the duodenum between the aorta and the superior mesenteric artery (SMA). Laparoscopic duodenojejunostomy has emerged as a safe and effective surgical treatment, particularly when conservative measures fail. We analyzed the clinical and surgical outcomes of 91 patients who underwent laparoscopic duodenojejunostomy for SMAS between February 2016 and July 2023. Preoperative clinical characteristics, surgical data, postoperative symptom improvement rates, and weight regain were evaluated. Diagnosis was confirmed through computed tomographic angiography (CTA), demonstrating an aortomesenteric angle < 20 degrees and distance < 10 mm. Conservative treatment was initially applied in all cases prior to surgical intervention. Among the 91 patients, 58.2% were female, and the mean age was 29.2 SD 11 years. All surgeries were completed laparoscopically with no intraoperative complications. After an average follow-up of 42.5 SD 26.7 months, 93.4% of patients showed significant symptom improvement, with a mean postoperative weight gain of 4.5 SD 2.5 kg. Postoperative complications included delayed gastric emptying in 8 patients (resolved conservatively) and low-output chylous fistulas in 4 patients (resolved spontaneously). There was no mortality. Laparoscopic duodenojejunostomy is a safe and effective treatment for SMAS, offering high success rates and minimal complications. While this study highlights the benefits of a multidisciplinary approach and standardized surgical techniques, further prospective studies are needed to optimize management protocols for this rare condition.