Surgical Endoscopy

, Volume 31, Issue 9, pp 3510–3518 | Cite as

Effects of laparoscopic myotomy on the esophageal motility pattern of esophageal achalasia as measured by high-resolution manometry

  • Renato SalvadorEmail author
  • Edoardo Savarino
  • Elisa Pesenti
  • Lorenzo Spadotto
  • Guerrino Voltarel
  • Giovanni Capovilla
  • Francesco Cavallin
  • Loredana Nicoletti
  • Michele Valmasoni
  • Alberto Ruol
  • Stefano Merigliano
  • Mario Costantini



Esophageal achalasia can be classified on the grounds of three distinct manometric patterns that correlate well with final outcome after laparoscopic Heller-Dor myotomy (LHM). No analytical data are available, however, on the postoperative picture and its possible correlation with final outcome. The aims of this study were: (a) to investigate whether manometric patterns change after LHM for achalasia; (b) to ascertain whether postoperative patterns and/or changes can predict final outcome; and (c) to test the hypothesis that the three known patterns represent different stages in the evolution of the disease.


During the study period, we prospectively enlisted 206 consecutive achalasia patients who were assessed using high-resolution manometry (HRM) before undergoing LHM. Symptoms were scored using a detailed questionnaire. Barium swallow, endoscopy and HRM were performed, before and again 6 months after surgery.


Preoperative HRM revealed the three known patterns with statistically different esophageal diameters (pattern I having the largest), and patients with pattern I had the highest symptom scores. The surgical treatment failed in 10 cases (4.9%). The only predictor of final outcome was the preoperative manometric pattern (p = 0.01). All patients with pattern I preoperatively had the same pattern afterward, whereas nearly 50% of patients with pattern III before LHM had patterns I or II after surgery. There were no cases showing the opposite trend.


Neither a change of manometric pattern after surgery nor a patient’s postoperative pattern was a predictor of final outcome, whereas preoperative pattern confirmed its prognostic significance. The three manometric patterns distinguishable in achalasia may represent different stages in the disease’s evolution, pattern III and pattern I coinciding with the early and final stages of the disease, respectively.


Achalasia Myotomy Heller-Dor Manometric pattern 


Compliance with ethical standards


Renato Salvador, Edoardo Savarino, Elisa Pesenti, Lorenzo Spadotto, Guerrino Voltarel, Giovanni Capovilla, Francesco Cavallin, Loredana Nicoletti, Michele Valmasoni, Alberto Ruol, Stefano Merigliano and Mario Costantini have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Renato Salvador
    • 1
    Email author
  • Edoardo Savarino
    • 1
  • Elisa Pesenti
    • 1
  • Lorenzo Spadotto
    • 1
  • Guerrino Voltarel
    • 1
  • Giovanni Capovilla
    • 1
  • Francesco Cavallin
    • 2
  • Loredana Nicoletti
    • 1
  • Michele Valmasoni
    • 1
  • Alberto Ruol
    • 1
  • Stefano Merigliano
    • 1
  • Mario Costantini
    • 1
  1. 1.Department of Surgical, Oncological and Gastroenterological SciencesUniversity of Padova, School of MedicinePaduaItaly
  2. 2.Esophageal and Digestive Tract Surgical Unit, Regional Centre for Esophageal DiseaseVeneto Institute of Oncology (IOV IRCCS)PaduaItaly

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