EFFICACY OF LAPROSCOPIC HELLER'S MYOTOMY IN THE TREATMENT OF ACHALASIA

Abstract

In a retrospective study conducted from September 6, 2021, to September 6, 2022, at the Thoracic Surgery Department of Bakhtawar Amin Trust Hospital in Multan, the objective was to evaluate the impact of laparoscopic Heller's Myotomy on patients with achalasia. Additionally, the study sought to identify pre-operative factors that influence treatment outcomes. The methodology involved recording pre-operative patient data, including dysphagia scores, and conducting pre-operative manometry to diagnose achalasia. The diagnostic criteria included a non-relaxing lower esophageal sphincter (LES) and abnormal esophageal contractions. Post-operative changes in dysphagia scores (delta) were calculated, and a dysphagia score falling below a specified cutoff was considered an unsuccessful treatment outcome. The study's results revealed that the patients had an average age of 48.5 years, with a standard deviation of 1.6. After Heller myotomy, the average decrease in dysphagia scores was 7.2, with a standard deviation of 2.5. A change in score of ≥5 was indicative of successful treatment, leading to dysphagia relief in 69 out of 80 patients (86%). The sole pre-operative variable that significantly predicted successful dysphagia relief was the pre-operative LES pressure. The responder group displayed higher LES pressure than the non-responder group, with 41.5 mm Hg ± 12.1 and 22.9 mm Hg ± 7.1, respectively (P = 0.001). No significant correlation was observed between post-operative LES pressure and changes in dysphagia scores. In conclusion, Heller's myotomy demonstrated excellent efficacy in providing dysphagia relief for achalasia patients. Notably, a high pre-operative LES pressure was identified as a significant predictor of an excellent treatment outcome.