{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:06:56Z","timestamp":1784779616053,"version":"3.55.0"},"reference-count":31,"publisher":"Springer Science and Business Media LLC","issue":"10","license":[{"start":{"date-parts":[[2023,7,30]],"date-time":"2023-07-30T00:00:00Z","timestamp":1690675200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,7,30]],"date-time":"2023-07-30T00:00:00Z","timestamp":1690675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009367","name":"Mansoura University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009367","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Many surgeons believe that pre-operative balloon dilatation makes laparoscopic myotomy more difficult in achalasia patients. Herein, we wanted to see if prior pneumatic balloon dilatation led to worse outcomes after laparoscopic myotomy. We also assessed if the frequency of dilatations and the time interval between the last one and the surgical myotomy could affect these outcomes.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The data of 460 patients was reviewed. They were divided into two groups: the balloon dilation (BD) group (102 patients) and the non-balloon dilatation (non-BD) group (358 patients).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Although pre-operative parameters and surgical experience were comparable between the two groups, the incidence of mucosal perforation, operative time, and intraoperative blood loss significantly increased in the BD group. The same group also showed a significant delay in oral intake and an increased hospitalization period. At a median follow-up of 4 years, the incidence of post-operative reflux increased in the BD group, while patient satisfaction decreased. Patients with multiple previous dilatations showed a significant increase in operative time, blood loss, perforation incidence, hospitalization period, delayed oral intake, and reflux esophogitis compared to single-dilatation patients. When compared to long-interval cases, patients with short intervals had a higher incidence of mucosal perforation and a longer hospitalization period.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Pre-operative balloon dilatation has a significant negative impact on laparoscopic myotomy short and long term outcomes. It is associated with a significant increase in operative time, blood loss, mucosal injury, hospitalization period, and incidence of reflux symptoms. More poor outcomes are encountered in patients with multiple previous dilatations and who have a short time interval between the last dilatation and the myotomy.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00464-023-10314-4","type":"journal-article","created":{"date-parts":[[2023,7,30]],"date-time":"2023-07-30T14:01:41Z","timestamp":1690725701000},"page":"7667-7675","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Pre-operative endoscopic balloon dilatation and its impact on outcome of laparoscopic Heller cardiomyotomy for patients with achalasia: does the frequency and interval matter?"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9834-7840","authenticated-orcid":false,"given":"El-Sayed Abou","family":"El-Magd","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Elgeidie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Youssif","family":"Elmahdy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr","family":"Abbas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Abdellatif","family":"Elyamany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahem Lotfy","family":"Abulazm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,7,30]]},"reference":[{"issue":"11","key":"10314_CR1","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1111\/j.1365-2036.2011.04655.x","volume":"33","author":"BK Enestvedt","year":"2011","unstructured":"Enestvedt BK, Williams JL, Sonnenberg A (2011) Epidemiology and practice patterns of achalasia in a large multi-centre database. Aliment Pharmacol Ther 33(11):1209\u20131214. https:\/\/doi.org\/10.1111\/j.1365-2036.2011.04655.x","journal-title":"Aliment Pharmacol Ther"},{"issue":"9","key":"10314_CR2","doi-asserted-by":"publisher","first-page":"e256","DOI":"10.1111\/j.1365-2982.2010.01511.x","volume":"22","author":"DC Sadowski","year":"2010","unstructured":"Sadowski DC, Ackah F, Jiang B, Svenson LW (2010) Achalasia: incidence, prevalence and survival. A population-based study. Neurogastroenterol Motil 22(9):e256\u2013e261. https:\/\/doi.org\/10.1111\/j.1365-2982.2010.01511.x","journal-title":"Neurogastroenterol Motil"},{"issue":"9","key":"10314_CR3","doi-asserted-by":"publisher","first-page":"1393","DOI":"10.14309\/ajg.0000000000000731","volume":"115","author":"MF Vaezi","year":"2020","unstructured":"Vaezi MF, Pandolfino JE, Yadlapati RH, Greer KB, Kavitt RT (2020) ACG clinical guidelines: diagnosis and management of achalasia. Am J Gastroenterol 115(9):1393\u20131411. https:\/\/doi.org\/10.14309\/ajg.0000000000000731","journal-title":"Am J Gastroenterol"},{"issue":"4","key":"10314_CR4","doi-asserted-by":"publisher","first-page":"467","DOI":"10.1177\/000313481808400415","volume":"84","author":"F Schlottmann","year":"2018","unstructured":"Schlottmann F, Neto RML, Herbella FAM, Patti MG (2018) Esophageal achalasia: pathophysiology, clinical presentation, and diagnostic evaluation. Am Surg 84(4):467\u2013472","journal-title":"Am Surg"},{"issue":"18","key":"10314_CR5","doi-asserted-by":"publisher","first-page":"1841","DOI":"10.1001\/jama.2015.2996","volume":"313","author":"JE Pandolfino","year":"2015","unstructured":"Pandolfino JE, Gawron AJ (2015) Achalasia: a systematic review. JAMA 313(18):1841\u20131852. https:\/\/doi.org\/10.1001\/jama.2015.2996","journal-title":"JAMA"},{"issue":"2","key":"10314_CR6","doi-asserted-by":"publisher","first-page":"e1376","DOI":"10.1590\/0102-672020180001e1376","volume":"31","author":"RM Laurino-Neto","year":"2018","unstructured":"Laurino-Neto RM, Herbella F, Schlottmann F, Patti M (2018) Evaluation of esophageal achalasia: from symptoms to the Chicago classification. Arq Bras Cir Dig 31(2):e1376. https:\/\/doi.org\/10.1590\/0102-672020180001e1376","journal-title":"Arq Bras Cir Dig"},{"issue":"7","key":"10314_CR7","doi-asserted-by":"publisher","first-page":"711","DOI":"10.1080\/17474124.2018.1481748","volume":"12","author":"F Schlottmann","year":"2018","unstructured":"Schlottmann F, Patti MG (2018) Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol 12(7):711\u2013721. https:\/\/doi.org\/10.1080\/17474124.2018.1481748","journal-title":"Expert Rev Gastroenterol Hepatol"},{"issue":"2","key":"10314_CR8","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1053\/j.sempedsurg.2017.02.001","volume":"26","author":"S Islam","year":"2017","unstructured":"Islam S (2017) Achalasia. Semin Pediatr Surg 26(2):116\u2013120. https:\/\/doi.org\/10.1053\/j.sempedsurg.2017.02.001","journal-title":"Semin Pediatr Surg"},{"issue":"4","key":"10314_CR9","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1097\/mog.0000000000000544","volume":"35","author":"G Zaninotto","year":"2019","unstructured":"Zaninotto G, Leusink A, Markar SR (2019) Management of achalasia in 2019. Curr Opin Gastroenterol 35(4):356\u2013362. https:\/\/doi.org\/10.1097\/mog.0000000000000544","journal-title":"Curr Opin Gastroenterol"},{"issue":"2","key":"10314_CR10","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1016\/s1091-255x(01)80033-0","volume":"5","author":"DR Urbach","year":"2001","unstructured":"Urbach DR, Hansen PD, Khajanchee YS, Swanstrom LL (2001) A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection. J Gastrointest Surg 5(2):192\u2013205. https:\/\/doi.org\/10.1016\/s1091-255x(01)80033-0","journal-title":"J Gastrointest Surg"},{"issue":"5","key":"10314_CR11","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1097\/01.sla.0000160702.31452.d5","volume":"241","author":"A Rosemurgy","year":"2005","unstructured":"Rosemurgy A, Villadolid D, Thometz D, Kalipersad C, Rakita S, Albrink M et al (2005) Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after botox or dilation. Ann Surg 241(5):725\u2013733. https:\/\/doi.org\/10.1097\/01.sla.0000160702.31452.d5. (discussion 33\u201335)","journal-title":"Ann Surg"},{"issue":"8","key":"10314_CR12","doi-asserted-by":"publisher","first-page":"1093","DOI":"10.1007\/s00423-010-0711-5","volume":"395","author":"CA Gutschow","year":"2010","unstructured":"Gutschow CA, T\u00f6x U, Leers J, Sch\u00e4fer H, Prenzel KL, H\u00f6lscher AH (2010) Botox, dilation, or myotomy? Clinical outcome of interventional and surgical therapies for achalasia. Langenbecks Arch Surg 395(8):1093\u20131099. https:\/\/doi.org\/10.1007\/s00423-010-0711-5","journal-title":"Langenbecks Arch Surg"},{"issue":"5","key":"10314_CR13","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1007\/s00464-002-8628-x","volume":"17","author":"WS Richardson","year":"2003","unstructured":"Richardson WS, Willis GW, Smith JW (2003) Evaluation of scar formation after botulinum toxin injection or forced balloon dilation to the lower esophageal sphincter. Surg Endosc 17(5):696\u2013698. https:\/\/doi.org\/10.1007\/s00464-002-8628-x","journal-title":"Surg Endosc"},{"issue":"6","key":"10314_CR14","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1007\/s004649901044","volume":"13","author":"S Horgan","year":"1999","unstructured":"Horgan S, Hudda K, Eubanks T, McAllister J, Pellegrini CA (1999) Does botulinum toxin injection make esophagomyotomy a more difficult operation? Surg Endosc 13(6):576\u2013579. https:\/\/doi.org\/10.1007\/s004649901044","journal-title":"Surg Endosc"},{"issue":"2","key":"10314_CR15","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/j.1442-2050.2008.00891.x","volume":"22","author":"K Tsuboi","year":"2009","unstructured":"Tsuboi K, Omura N, Yano F, Kashiwagi H, Yanaga K (2009) Results after laparoscopic Heller-Dor operation for esophageal achalasia in 100 consecutive patients. Dis Esophagus 22(2):169\u2013176. https:\/\/doi.org\/10.1111\/j.1442-2050.2008.00891.x","journal-title":"Dis Esophagus"},{"issue":"3","key":"10314_CR16","first-page":"301","volume":"28","author":"F Torresan","year":"2015","unstructured":"Torresan F, Ioannou A, Azzaroli F, Bazzoli F (2015) Treatment of achalasia in the era of high-resolution manometry. Ann Gastroenterol 28(3):301\u2013308","journal-title":"Ann Gastroenterol"},{"issue":"2","key":"10314_CR17","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1007\/s00464-005-0365-5","volume":"20","author":"N Omura","year":"2006","unstructured":"Omura N, Kashiwagi H, Ishibashi Y, Yano F, Tsuboi K, Kawasaki N et al (2006) Laparoscopic Heller myotomy and Dor fundoplication for the treatment of achalasia. Assessment in relation to morphologic type. Surg Endosc 20(2):210\u2013213. https:\/\/doi.org\/10.1007\/s00464-005-0365-5","journal-title":"Surg Endosc"},{"issue":"9881","key":"10314_CR18","doi-asserted-by":"publisher","first-page":"1933","DOI":"10.1016\/s0140-6736(12)62171-0","volume":"381","author":"AJ Bredenoord","year":"2013","unstructured":"Bredenoord AJ, Pandolfino JE, Smout AJ (2013) Gastro-oesophageal reflux disease. Lancet 381(9881):1933\u20131942. https:\/\/doi.org\/10.1016\/s0140-6736(12)62171-0","journal-title":"Lancet"},{"issue":"12","key":"10314_CR19","doi-asserted-by":"publisher","first-page":"2095","DOI":"10.1007\/s11605-009-1049-6","volume":"13","author":"CW Snyder","year":"2009","unstructured":"Snyder CW, Burton RC, Brown LE, Kakade MS, Finan KR, Hawn MT (2009) Multiple preoperative endoscopic interventions are associated with worse outcomes after laparoscopic Heller myotomy for achalasia. J Gastrointest Surg 13(12):2095\u20132103. https:\/\/doi.org\/10.1007\/s11605-009-1049-6","journal-title":"J Gastrointest Surg"},{"issue":"3","key":"10314_CR20","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1097\/01.sla.0000114228.34809.01","volume":"239","author":"I Gockel","year":"2004","unstructured":"Gockel I, Junginger T, Bernhard G, Eckardt VF (2004) Heller myotomy for failed pneumatic dilation in achalasia: how effective is it? Ann Surg 239(3):371\u2013377. https:\/\/doi.org\/10.1097\/01.sla.0000114228.34809.01","journal-title":"Ann Surg"},{"key":"10314_CR21","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-023-02680-2","author":"EA El-Magd","year":"2023","unstructured":"El-Magd EA, Elgeidie A, Abbas A, Elmahdy Y, Abulazm IL (2023) Mucosal injury during laparoscopic Heller cardiomyotomy: risk factors and impact on surgical outcomes. Surg Today. https:\/\/doi.org\/10.1007\/s00595-023-02680-2","journal-title":"Surg Today"},{"issue":"5","key":"10314_CR22","doi-asserted-by":"publisher","first-page":"362","DOI":"10.1097\/SLE.0000000000000647","volume":"29","author":"A El Nakeeb","year":"2019","unstructured":"El Nakeeb A, Ezzat H, Shehta A et al (2019) Impact of the myotomy extent on gastric side on surgical outcome after Heller\u2019s cardiomotomy for achalasia. Surg Laparosc Endosc Percutaneous Tech 29(5):362\u2013366. https:\/\/doi.org\/10.1097\/SLE.0000000000000647","journal-title":"Surg Laparosc Endosc Percutaneous Tech"},{"issue":"4","key":"10314_CR23","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1007\/s004649900363","volume":"11","author":"M Morino","year":"1997","unstructured":"Morino M, Rebecchi F, Festa V, Garrone C (1997) Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy. Surg Endosc 11(4):359\u2013361. https:\/\/doi.org\/10.1007\/s004649900363","journal-title":"Surg Endosc"},{"issue":"5","key":"10314_CR24","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1007\/s004649901020","volume":"13","author":"IJ Beckingham","year":"1999","unstructured":"Beckingham IJ, Callanan M, Louw JA, Bornman PC (1999) Laparoscopic cardiomyotomy for achalasia after failed balloon dilatation. Surg Endosc 13(5):493\u2013496. https:\/\/doi.org\/10.1007\/s004649901020","journal-title":"Surg Endosc"},{"issue":"5","key":"10314_CR25","doi-asserted-by":"publisher","first-page":"579","DOI":"10.1097\/01.sla.0000217524.75529.2d","volume":"243","author":"CD Smith","year":"2006","unstructured":"Smith CD, Stival A, Howell DL, Swafford V (2006) Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg 243(5):579\u2013584. https:\/\/doi.org\/10.1097\/01.sla.0000217524.75529.2d. (discussion 84\u201386)","journal-title":"Ann Surg"},{"issue":"2","key":"10314_CR26","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1016\/0003-4975(96)00176-2","volume":"62","author":"MK Ferguson","year":"1996","unstructured":"Ferguson MK, Reeder LB, Olak J (1996) Results of myotomy and partial fundoplication after pneumatic dilation for achalasia. Ann Thorac Surg 62(2):327\u2013330","journal-title":"Ann Thorac Surg"},{"issue":"2","key":"10314_CR27","doi-asserted-by":"publisher","first-page":"706","DOI":"10.1007\/s00464-015-4264-0","volume":"30","author":"K Tsuboi","year":"2016","unstructured":"Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S et al (2016) Identification of risk factors for mucosal injury during laparoscopic Heller myotomy for achalasia. Surg Endosc 30(2):706\u2013714. https:\/\/doi.org\/10.1007\/s00464-015-4264-0","journal-title":"Surg Endosc"},{"issue":"1","key":"10314_CR28","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1007\/s10388-017-0593-5","volume":"15","author":"K Tsuboi","year":"2018","unstructured":"Tsuboi K, Omura N, Yano F, Hoshino M, Yamamoto SR, Akimoto S et al (2018) Impact of preoperative balloon dilatation on outcomes of laparoscopic surgery in young patients with esophageal achalasia. Esophagus 15(1):39\u201346. https:\/\/doi.org\/10.1007\/s10388-017-0593-5","journal-title":"Esophagus"},{"issue":"9","key":"10314_CR29","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1016\/j.gassur.2005.10.001","volume":"9","author":"G Portale","year":"2005","unstructured":"Portale G, Costantini M, Rizzetto C, Guirroli E, Ceolin M, Salvador R et al (2005) Long-term outcome of laparoscopic Heller-Dor surgery for esophageal achalasia: possible detrimental role of previous endoscopic treatment. J Gastrointest Surg 9(9):1332\u20131339. https:\/\/doi.org\/10.1016\/j.gassur.2005.10.001","journal-title":"J Gastrointest Surg"},{"issue":"2","key":"10314_CR30","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1016\/s1091-255x(02)00159-2","volume":"7","author":"M Bloomston","year":"2003","unstructured":"Bloomston M, Fraiji E, Boyce HW Jr, Gonzalvo A, Johnson M, Rosemurgy AS (2003) Preoperative intervention does not affect esophageal muscle histology or patient outcomes in patients undergoing laparoscopic Heller myotomy. J Gastrointest Surg 7(2):181\u2013188. https:\/\/doi.org\/10.1016\/s1091-255x(02)00159-2. (discussion 8\u201390)","journal-title":"J Gastrointest Surg"},{"issue":"3","key":"10314_CR31","doi-asserted-by":"publisher","first-page":"1427","DOI":"10.1007\/s00464-016-5133-1","volume":"31","author":"Y Souma","year":"2017","unstructured":"Souma Y, Nakajima K, Taniguchi E, Takahashi T, Kurokawa Y, Yamasaki M et al (2017) Mucosal perforation during laparoscopic surgery for achalasia: impact of preoperative pneumatic balloon dilation. Surg Endosc 31(3):1427\u20131435. https:\/\/doi.org\/10.1007\/s00464-016-5133-1","journal-title":"Surg Endosc"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-023-10314-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-023-10314-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-023-10314-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,25]],"date-time":"2023-09-25T21:06:17Z","timestamp":1695675977000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-023-10314-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,30]]},"references-count":31,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10314"],"URL":"https:\/\/doi.org\/10.1007\/s00464-023-10314-4","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,30]]},"assertion":[{"value":"24 March 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 July 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Drs. El-Sayed Abou El-Magd, Ahmed Elgeidie, Youssif Elmahdy, Amr Abbas, Mohamed Abdellatif Elyamany, and Ibrahem Lotfy Abulazm have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}}]}}