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Achalasia holds a great functional impact for patients. There is still a lot of debate concerning the ideal initial treatment for patients suffering from this disease: conservative treatment versus surgery. In this study we present our long-term results with minimally invasive surgery. From a retrospective database, we selected all patients with achalasia treated surgically through a minimally invasive approach at UZ Gasthuisberg, Leuven, Belgium, between January 1998 and June 2015. We used the postoperative Eckardt Score as primary outcome parameter, postoperative gastroesophageal reflux and the need for secondary interventions were secondary outcome parameters. A total of 115 patients received a laparoscopic Heller myotomy (LHM), 13 received a minimally invasive esophagectomy (MIE) for end-stage achalasia. In the LHM-group, we did a subgroup analysis of patients who had received conservative therapy before surgery (n = 90) and a subgroup who had not (n = 25). There was no statistical significant difference in postoperative Eckardt Score. At every time point, more than 85% of the patients had a postoperative Eckardt Score <4, signifying a good result. There was no statistical significant difference between the subgroups when analyzed for gastroesophageal reflux, nor concerning the need for reintervention. We can conclude that surgery still holds its place in the treatment of achalasia and can be selected as primary therapy, with few complications and a good outcome. There is no difference in outcome between patients who already had a form of therapy when compared to those who did not. In our center, we have comparable results to other centers, although there is few data concerning a longer follow-up.

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Background: Laparoscopic antirefluxsurgery (LARS) is the surgical treatment option in patients with gastroesophageal reflux disease (GERD). Laparoscopic 360° Nissen fundoplication (LNF) is the most performed type of LARS. However, troublesome side effects such as dysphagia and gas bloating of the LNF made surgeons to seek alternatives. Laparoscopic posterior 270° Toupet fundoplication (LTF) and laparoscopic 180° anterior fundoplication (LAF) have been developed to reduce these troublesome side effects. In LARS there is an ongoing debate which type of LARS provides the best reflux control while mitigating the side effects. Objective: We try to contribute to this debate by finding out which type of LARS is suggested to be superior and should be the surgical intervention to treat GERD. Moreover, we try to gather information on quality of life (QOL), the value of preoperative workup , failure and reoperation in LARS. Methods: We performed a literature review with targeted searches in Pubmed and EMBASSE. Twenty-two papers were included, 6 of them were randomized control trials (RCTs). Results: At 2 and 5 years after surgery, LTF and LAF have an advantage over LNF. At 1 year postoperatively, no differences are found between LTF and LAF. On long-term (>10 years) results of all types of fundoplications seem equal. QOL is a very good and important dimension to evaluate LARS. The value of a thoroughly preoperative workup is emphasized strongly. Management of failed LARS is complex and is reserved for experienced institutions. Conclusion: Nowadays a perfect type of laparoscopic antireflux surgery to treat GERD does not exist in the literature. New technologies should be developed.

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Introduction: Zenker’s diverticula (ZD) are associated with a wide range of symptoms such as dysphagia, regurgitation of undigested food and halitosis. It is believed that ZD are formed through pulsion forces in a weak area of the hypopharyngeal wall. Poor upper esophageal sphincter (UES) compliance is the presumed pathophysiologic mechanism, yet, the underlying pathophysiology is still unknown. This study aimed to characterize pharyngo-esophageal function in ZD patients using high resolution manometry with impedance (HRIM) Material & Methods: 21 ZD patients (14M, 70±10 yrs) and 48 healthy adults (18M, 51±17 yrs) were included. All patients had HRIM pre-surgery (myotomy and pexy) and 5 patients post-surgery. Swallow Gateway™ analysis (swallowgateway.com) was used to analyze the recordings and determine metrics of pharyngeal function for 10ml liquid swallows. Results: Compared to controls, patients had increased swallow dysfunction (SRI), intrabolus distention pressures (IBP), UES and pharyngeal contractile pressures (UESCI, PhCI); and decreased UES relaxation (UES IRP), opening time (UES Open Time) and aberrant flow timing (DCL). All pre-surgery patients had reduced opening extent (UES Max Adm) due to impaired relaxation (20/21), low distention pressures (4/21) or low pharyngeal contractility (9/16). 4/21 patients aspirated. Basal UES pressure was not altered in pre- or post-surgery patients compared to controls. Conclusions: ZD patients demonstrate altered swallowing biomechanics consistent with obstructive pathology. In the subgroup of patients assessed post-operatively the biomechanical measures remained consistent with structural pathology.

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ABSTRACT Objectives The Abramson procedure is a relative new minimally invasive procedure for Pectus Carinatum (PC) repair. Half 2013 the Abramson procedure was introduced in our centre as alternative treatment for PC. The objective of this study was to evaluate the initial experience obtained three years after the implementation of the Abramson procedure in our institution and to assess postoperative quality of life (QoL). Methods In this single centre retrospective study we analysed the complications after the Abramson procedure, graded according to the Clavien-Dindo classification. Patients were enrolled in the time period between August 2013 and December 2015. In the prospective part of this study health questionnaires (EQ-5D- 5L, SF-36 and Single Step Questionnaire) were sent to the patients after consent of our local ethical committee. Results 20 patients, all male, were included in the study. Median age at time of surgery was 14.92 years. In all of the patients low self-esteem was an indication for surgery. All patients received a patient-controlled epidural analgesia for 5 days. Median length of stay was 7 days. In 12/20 patients the bar is already removed after a median treatment duration of 1.95 years. There were 23 complications early postoperatively, mostly pneumothorax (n=17). One patient needed revisional surgery for bar dislocation. During the two-year treatment 9 patients had an uncomplicated treatment pathway. 10 patients had grade I complications (breakage of cable). Two patients had neuropathy treated with medication. Mean EQ- 5D-5L-VAS-score in our population was 87.31 compared to 82.8 in the Flemish control group (p=0.017). SF-36 revealed that the mean value for each domain was above the norm. Conclusions Our initial experience with the Abramson procedure shows a good complication profile for this minimal invasive technique. Results of the three health questionnaires (EQ-5D-5L, SF-36 and Single Step Questionnaire) demonstrate a good influence of this new surgical technique on the postoperative quality of life. Postoperative quality of life is at least at the same level of the control group.