Abstract
Currently, the most effective therapy for achalasia is laparoscopic Heller myotomy with partial fundoplication. The aim of this study was to compare the long-term results between 2 different laparoscopic operation techniques in achalasia treatment. This was a retrospective study, where 46 achalasia patients were examined: 23 patients underwent laparoscopic Heller myotomy followed by the full gastric fundus mobilization, total hiatal dissection, and posterior Toupet (270°) fundoplication (group 1); other 23 patients underwent laparoscopic Heller myotomy with limited surgical cardia region dissection, not dividing the short gastric vessels and performing anterior partial Dor fundoplication (group 2). Long-term findings included the evaluation of postoperative dysphagia according Vantrappen and Hellemans and intensity of heartburn according the standard grading system. The patients in these 2 groups were similar in terms of age, weight, height, and postoperative hospital stay. The median follow-up was 66 months in the group 1 and 39 months in the group 2 (P<0.05). Laparoscopic operation was effective in 82.6% of patients (excellent and good results) in the group 1; treatment was effective in 78.3% of patients in the group 2 (P>0.05). Clinically significant heartburn was documented in 39% of patients in the group 1 and only in 13% of patients in the group 2 (P<0.05). According our study results, both laparoscopic techniques were similarly effective (82.6% vs. 78.3%) in achalasia treatment. Postoperative heartburn was significantly more common (39% vs. 13%) after laparoscopic myotomy, followed by the full gastric fundus mobilization, total hiatal dissection, and posterior Toupet (270°) fundoplication.
Highlights
Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder, which causes progressive dysphagia, regurgitation, and weight loss [1]
Both laparoscopic techniques were effective (82.6% vs. 78.3%) in achalasia treatment
Dysphagia relief is maintained in 85%– 100% of patients who underwent laparoscopic Heller myotomy [3], persistent dysphagia and postoperative gastroesophageal reflux (GER) are the most cited reasons for surgical failure
Summary
Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder, which causes progressive dysphagia, regurgitation, and weight loss [1]. Achalasia results from the irreversible destruction of esophageal myenteric plexus neurons causing aperistalsis and failed lower sphincter relaxation. The application of laparoscopic myotomy technique has allowed many surgeons and gastroenterologists to recommend surgery as the primary treatment [2,3]. Dysphagia relief is maintained in 85%– 100% of patients who underwent laparoscopic Heller myotomy [3], persistent dysphagia and postoperative gastroesophageal reflux (GER) are the most cited reasons for surgical failure. A randomized, controlled trial by Csendes et al [4] reported that poor outcomes at 15.8 years after myotomy were the result of severe reflux disease but not of incomplete myotomy in 92% of patients.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
