519. ROBOTIC HELLER DOR FOR SYMPTOMATIC ACHALASIA. A SINGLE TERTIARY CENTER EXPERIENCE

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Abstract Background Minimally invasive Heller-Dor is the best therapeutic option for symptomatic achalasia. The aim of this study is to describe the introduction of Robotic program for Heller-Dor procedure (RAHD) in a tertiary center evaluating clinical and surgical outcome. Methods We performed a retrospective analysis of patients diagnosed with symptomatic achalasia through clinical, endoscopic, and manometric workup, that were eligible for RAHD. We included all consecutive patients underwent RADH between September 2019 and December 2023 using the DaVinci Xi surgical system. Patients with previous endoscopic or surgical treatment for achalasia were excluded. Results Data from 44 patients were collected. Patients’ characteristics are summarized in table 1. Most patients were in good clinical condition with an ASA score 1-2 and a CCI 1-2 in more than 80% of cases. Mean Eckhardt score (ES) was 6 (SD 2.05). Most frequent symptom was dysphagia, present in all patients but with different severity. Mean operating time was 184 minutes (SD 46). Mucosal tear occurred in three cases and all were sutured immediately, an abdominal drain was placed only in the first case. A regular postoperative course was observed in all patients. All patients underwent a post-op gastrografin esophagogram before starting a liquid diet; none revealed leakage or treatment failure. Three patients (6,8 %) experienced Clavien-Dindo grade I complication, one hepatic hematoma, one pneumothorax, and one PONV. No severe complications were reported. Maximum length of hospital stay was 4 days, mean 3.2 (SD 0.42). All patients were discharged with a well-tolerated soft diet. Mean ES at follow up was 0.58 (SD 0.7) at 1 months. After 6 months and 1 year, no patients reported recurrence of symptoms (ES <3), but three patients reported symptomatic reflux (6,8%). Conclusion Our experience suggests that introduction of RAHD is safe and effective in the treatment of symptomatic achalasia in a tertiary center for Upper Gastrointestinal Surgery.