Surgical Endoscopy

, Volume 22, Issue 6, pp 1493–1499 | Cite as

Patterns of esophageal acid exposure after laparoscopic Heller’s myotomy and Dor’s fundoplication for esophageal achalasia

  • John Tsiaoussis
  • George Pechlivanides
  • Nikolaos Gouvas
  • Elias Athanasakis
  • Nikolaos Zervakis
  • Apostolos Manitides
  • Evaghelos Xynos
Article

Abstract

Background

Heller’s myotomy for esophageal achalasia is associated with less esophageal acid gastroesophageal reflux when combined a Dor’s fundoplication.

The Aim of the study was to assess the incidence of postoperative esophageal acid exposure after laparoscopic Heller’s myotomy and Dor’s fundoplication (HM-DF).

Methods

Seventy six patients (37 males) with esophageal achalasia were prospectively followed-up by clinical interview and laboratory tests before and after laparoscopic HM-DF. A symptom score was used for clinical assessment. Laboratory assessment included esophageal standard manometry, esophagogram and esophageal pH 24-hour monitoring before and 1- and 5-years after surgery.

Results

Symptom score improved at 1-year after surgery (< 0.001). Heartburn was only reported by 5 patients, dysphagia or/and regurgitation by 28 and substernal pain by 12. 91% of patients had satisfactory functional results. Pathological esophageal exposure to acid was seen in 21% of the cases. Pathological acid events showed the features of pseudoreflux in 66%t and those of true GER in 34%. Pathologically increased esophageal exposure to acid was more commonly detected in patients with a pseudodiverticulum (= 0.001) and was related to the diameter of distal esophagus and symptom score (< 0.001). There was no reduction in esophageal acid exposure after treatment with proton pump inhibitors in 16 patients. Neither the symptom score nor esophageal acid exposure at esophageal pH monitoring changed significantly at the 5-year follow-up in 35 patients. Esophageal configuration remained unchanged.

Conclusions

Increased esophageal exposure to acid after laparoscopic HM-DF for esophageal achalasia i) is detected in 21% of patients, and is rather the result of food stagnation than of true GER, ii) is more commonly seen in cases with pseudodiverticulum, iii) is related to the diameter of distal esophagus, iv) does not respond to antisecretory treatment and v) does not deteriorate by time.

Keywords

Esophageal Achalasia Heller’s Myotomy Dor’s Fundoplication Esophageal Acid Monitoring Esophageal Barium Study Esophageal Manometry Gastroesophageal Reflux 

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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • John Tsiaoussis
    • 1
  • George Pechlivanides
    • 2
  • Nikolaos Gouvas
    • 3
  • Elias Athanasakis
    • 3
  • Nikolaos Zervakis
    • 3
  • Apostolos Manitides
    • 4
  • Evaghelos Xynos
    • 3
  1. 1.Department of SurgeryMetropolitan Hospital of AthensAthensGreece
  2. 2.First Department of SurgeryAthens Naval and Veterans HospitalAthensGreece
  3. 3.Unit of Gastrointestinal Motiltiy University Hospital of HeraklionHeraklionGreece
  4. 4.Department of GastroenterologyAthens Naval and Veterans HospitalAthensGreece

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