Journal of Gastrointestinal Surgery

, Volume 18, Issue 1, pp 106–112

Laparoscopic Heller Myotomy Can Be Used As Primary Therapy for Esophageal Achalasia Regardless of Age

Authors

  • Renato Salvador
    • Department of Surgery, Oncology and GastroenterologyUniversity of Padova
  • Mario Costantini
    • Department of Surgery, Oncology and GastroenterologyUniversity of Padova
  • Francesco Cavallin
    • Surgical OncologyIstituto Oncologico Veneto, IOV-IRCCS
  • Lisa Zanatta
    • Department of Surgery, Oncology and GastroenterologyUniversity of Padova
  • Elena Finotti
    • Department of Surgery, Oncology and GastroenterologyUniversity of Padova
  • Cristina Longo
    • Department of Surgery, Oncology and GastroenterologyUniversity of Padova
  • Loredana Nicoletti
    • Department of Surgery, Oncology and GastroenterologyUniversity of Padova
  • Giovanni Capovilla
    • Department of Surgery, Oncology and GastroenterologyUniversity of Padova
  • Romeo Bardini
    • Department of Surgery, Oncology and GastroenterologyUniversity of Padova
    • Department of General SurgerySS Giovanni e Paolo Hospital
    • Unità Operativa Complessa Chirurgia GeneraleUniversity of Padova Department of Surgery, Oncology and Gastoenterology
2013 SSAT Plenary Presentation

DOI: 10.1007/s11605-013-2334-y

Cite this article as:
Salvador, R., Costantini, M., Cavallin, F. et al. J Gastrointest Surg (2014) 18: 106. doi:10.1007/s11605-013-2334-y

Abstract

Introduction

Laparoscopic Heller-Dor surgery is the current treatment of choice for patients with esophageal achalasia, but elderly patients are generally referred for less invasive treatments (pneumatic dilations or botulinum toxin injections).

Aim

To assess the effect of age on the surgical outcome of patients receiving laparoscopic Heller-Dor as primary treatment.

Methods

Demographic and clinical findings were prospectively collected on patients undergoing laparoscopic Heller-Dor from 1992 to 2012. Patients were classified in three age brackets: group A (≤45 years), group B (45–70), and group C (≥70). Treatment was defined as a failure if the postoperative symptom score was >10th percentile of the preoperative score (i.e., >8). We consecutively performed the Heller-Dor in 571 achalasia patients, 305 (53.4 %) in group A, 226 (39.6 %) in group B, and 40 (7 %) in group C.

Results

The mortality was nil; the conversion and morbidity rates were both 1.1 %. Group C patients had higher preoperative symptom scores (p = 0.02), while the symptom duration was similar in all three groups. Mucosal tears occurred in 17 patients (3 %): 6 (2 %) in group A, 8 (3.5 %) in group B, and 3 (7.5 %) in group C (p = 0.09). The postoperative hospital stay was slightly longer for group C (p = 0.06).

Discussion

The treatment failure rate was quite similar: 31 failures in group A (10.1 %), 19 in group B (8.4 %), and 3 in group C (7.5 %; p = 0.80). These failures were seen more in manometric pattern III (22.2 %, p = 0.002). Laparoscopic Heller-Dor can be used as the first therapeutic approach to achalasia even in elderly patients with an acceptable surgical risk.

Keywords

Esophageal achalasiaHeller-DorElderly

Copyright information

© The Society for Surgery of the Alimentary Tract 2013