Abstract
Background: The incidence of achalasia in sub- Saharan Africa is not known. Experience in our region suggests the disorder affects mainly younger patients. Esophagomyotomy is the gold standard treatment for achalasia. Benefits of laparoscopic treatment are well documented in western populations. African data isinsufficient.Methods: A retrospective review of patients over 16 years who underwent esophagomyotomy at Tenwek Hospital (2008–2017). The primary outcome was improvement in symptoms before and after surgery as measured using the Eckardt score— lower scores for dysphagia, regurgitation, pain, weight loss indicate less severe symptoms. The secondary outcomes were duration of surgery, length of myotomy, length of hospital stay, and complication rate. Data analysis used ANOVA.Results: 54 patients were included: 28 with laparoscopic Heller myotomy (LHM), 26 with open Heller myotomy (OHM). LHM patients were younger than OHM patients (p<0.05). Patients who had LHM had lower postoperative Eckardt scores (p<0.05). Duration of surgery for LHM was longer (p<0.001) than for OHM, conversion rate was 10.71%, and length of the myotomy was unaltered. No difference was seen in hospital stay or complication rate between the two groups.Conclusion: LHM is effective and safe in a rural East African setting, with excellent functional outcomes compared with open techniques. Thus, laparoscopy can be feasible worldwide.Keywords: Laparoscopic, Heller Esophagomyotomy, Tenwek Hospital, Achalasia
Highlights
Esophagomyotomy (Heller myotomy) is described as the gold standard treatment for esophageal achalasia [1,2]
We reviewed retrospectively records of all patients who had a diagnosis of achalasia and who underwent laparoscopic Heller myotomy (LHM) or www.annalsofafricansurgery.com
The t mean preoperative ESS for the total patient of stay, with LHM being slightly shorter than open Heller myotomy (OHM), population was 7.14, indicating symptoms as being or in complication rate, which was 7.14% overall
Summary
Esophagomyotomy (Heller myotomy) is described as the gold standard treatment for esophageal achalasia [1,2]. Treatment of achalasia involves myotomy and has been commonly managed with laparoscopic Heller myotomy (LHM). We sought to evaluate the efficacy and safety of LHM in our population We undertook this 9-year retrospective review to compare LHM with open Heller myotomy (OHM). The secondary outcomes were duration of surgery, length of myotomy, length of hospital stay, and complication rate. Results: 54 patients were included: 28 with laparoscopic Heller myotomy (LHM), 26 with open Heller myotomy (OHM). Duration of surgery for LHM was longer (p
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