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Therapeutic efficacy of laparoscopic Heller-Dor surgery for chest pain in patients with achalasia: a single institutional experience

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Abstract

Background

Chest pain reduces the quality of life of patients with achalasia. Although laparoscopic Heller-Dor surgery (LHD) is a standard surgical treatment for achalasia, its therapeutic efficacy for chest pain is not clear. The present study evaluated the therapeutic efficacy of LHD for chest pain and tried to identify factors associated with the relief of chest pain.

Methods

The study included 244 patients with preoperative chest pain who underwent LHD as the first surgical intervention. The questionnaire-based symptom frequency score was multiplied by the severity score, and the calculated metric was defined as the symptom score. The study population was stratified, by the change in the chest pain symptom score, into Complete Remission (CR), Partial Remission (PR), and No Remission (NR) groups, which were compared for patient background and surgical outcome. Multivariate analysis was also performed to determine factors associated with the relief of chest pain.

Results

As for preoperative clinicopathological conditions, the CR subgroup was older (p = 0.0169) with fewer previous balloon dilatations (p = 0.009). Although no difference was detected in the surgical outcome, the NR group had higher postoperative symptom scores for both difficulty in swallowing and vomiting and a lower score for patient satisfaction with surgery (p = 0.0141). Multivariate analysis detected two factors associated with CR: disease duration over 60 months and less than two previous balloon dilatations.

Conclusions

LHD improved chest pain symptoms in 90% of patients with achalasia. The patients who achieved relief of chest pain were characterized by disease duration over 60 months and less than two previous balloon dilatations.

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Abbreviations

LHD:

Laparoscopic Heller-Dor

CR:

Complete remission

PR:

Partial remission

NR:

No remission

LES:

Lower esophageal sphincter

QOL:

Quality of life

TBE:

Timed barium esophagogram

St:

Straight type

Sig:

Sigmoid type

BMI:

Body mass index

OL:

Overall length of LES

AL:

Abdominal length of LES

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Authors and Affiliations

  1. Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Kazuto Tsuboi, Nobuo Omura, Fumiaki Yano, Masato Hoshino, Se-Ryung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, Hideyuki Kashiwagi & Katsuhiko Yanaga

Authors
  1. Kazuto Tsuboi
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  2. Nobuo Omura
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  3. Fumiaki Yano
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  4. Masato Hoshino
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  5. Se-Ryung Yamamoto
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  6. Shunsuke Akimoto
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  7. Takahiro Masuda
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  8. Hideyuki Kashiwagi
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  9. Katsuhiko Yanaga
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Contributions

Kazuto Tsuboi analyzed data and wrote the manuscript. Nobuo Omura supervised the study and critically revised the manuscript. Fumiaki Yano, Masato hoshino, Se-Ryung Yamamoto, Shunsuke Akimoto, Takahiro Masuda, and Hideyuki Kashiwagi collected data. Katsuhiko Yanaga critically revised the manuscript.

Corresponding author

Correspondence to Kazuto Tsuboi.

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Ethical Statement

The protocol of this study has been approved by the Jikei University School of Medicine Institutional Review Board (#28-047 [8290]). All informed consent was obtained from the subjects and guardians.

Conflict of interest

Drs. Tsuboi, Omura, Yano, Hoshino, Yamamoto, Akimoto, Masuda, Kashiwagi and Yanaga have no conflicts of interest or financial ties to disclose.

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Tsuboi, K., Omura, N., Yano, F. et al. Therapeutic efficacy of laparoscopic Heller-Dor surgery for chest pain in patients with achalasia: a single institutional experience. Esophagus 17, 197–207 (2020). https://doi.org/10.1007/s10388-019-00697-6

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  • DOI: https://doi.org/10.1007/s10388-019-00697-6

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