Abstract
Aim of this study was to review our experience with laparoscopic Heller–Dor (LHD) intervention and identify possible success predictors. LHD is an effective and safe treatment for achalasia. However, open debates are still held on which antireflux procedure should be added and on how long the myotomy on to the stomach should be. A lot of successful outcome predictors have been investigated with sometimes conflicting results. 137 achalasic patients underwent LHD at our institution. Pre-operatively all underwent a complete morphologic and functional work-up. Follow-up visits were scheduled at 1, 3, 6 months and then every year. Median follow-up was 65 months. Pre-operatively dysphagia was present in 100% cases, regurgitation in 84.6% and mean lower esophageal sphincter (LES) resting pressure was 29.1 mmHg. We observed 3 mucosal perforations. Mortality was null. The median of oral food intake resumption was second post-operative day and mean post-operative hospital stay was 3.4 days. Dysphagia was treated with success in 94.78% cases and regurgitation in 82.84%. Post-operative mean LES resting pressure was 13.64 mmHg. New-onset heartburn was observed in 10.9% of patients. 9.7% of cases required pneumatic dilations and 1.5% a laparoscopic re-do myotomy. An high pre-operative dysphagia score resulted to be the only statistically significant prognostic factor. Sex, age, dysphagia duration and LES resting pressure did not reach statistical significance. LHD is a safe procedure with good results in about 90% of patients even at a long-term follow-up. Predictors of successful outcome are still poorly plain and sometimes conflicting in literature.
Similar content being viewed by others
References
Pohl D, Tutuian R (2007) Achalasia: an overview of diagnosis and treatment. J Gastrointestin Liver Dis 16(3):297–303
Mayberry JF (2001) Epidemiology and demographics of achalasia. Gastrointest Endosc Clin N Am 11:235–248
Shimi S, Nathanson LK, Cuschieri A (1991) Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb 36:152–154
Roberts KE, Duffy AJ, Bell RL (2006) Controversies in the treatment of gastroesophageal reflux and achalasia. World J Gastroenterol 12(20):3155–3161
Torquati A, Richards WO, Holzman MD, Sharp KW (2006) Laparoscopic myotomy for achalasia. Predictors of successful outcome after 200 cases. Ann Surg 243(5):587–593
Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia. A prospective randomized double-blind clinical trial. Ann Surg 240(3):405–415
Arain MA, Peters JH, Tamhankar AP, Portale G, Almogy G, DeMeester SR, Crookes PF, Hagen JA, Bremner CG, DeMeester TR (2004) Preoperative lower esophageal sphincter pressure affects outcome of laparoscopic esophageal myotomy for achalasia. J Gastrointest Surg 8(3):328–334
Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S, Way LW (2001) Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg 136:870–877
Wright AS, Williams CW, Pellegrini CA, Oelschlager BK (2007) Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc 21:713–718
Zaninotto G, Costantini M, Molena D, Buin F, Carta A, Nicoletti L, Ancona E (2000) Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg 4(3):282–289
Richardson WS, Kennedy CI, Bolton JS (2006) Mid-term follow-up evaluation after a novel approach to anterior fundoplication for achalasia. Surg Endosc 20(12):1914–1918
Rossetti G, Brusciano L, Amato G, Maffettone V, Napolitano V, Russo G, Izzo D, Russo F, Pizza F, Del Genio G, Del Genio A (2005) A total fundoplication is not an obstacle to esophageal emptying after Heller myotomy for achalasia: results of a long term follow-up. Ann Surg 241(4):614–621
Zhu ZJ, Chen LQ, Duranceau A (2008) Long term results of total versus partial fundoplication following esophagomyotomy for primary esophageal motor disorders. World J Surg 32(3):401–407
Schuchert MJ, Luketich JD, Landreneau RJ, Kilic A, Gooding WE, Alvelo-Rivera M, Christie NA, Gilbert S, Pennathur A (2008) Minimally-invasive esophagomyotomy in 200 consecutive patients: factors influencing post-operative outcomes. Ann Thorac Surg 85(5):1729–1734
Rosen MJ, Novitsky YW, Cobb WS, Kercher KW, Heniford BT (2007) Laparoscopic Heller myotomy for achalasia in 101 patients: can successful symptomatic outcome be predicted? Surg Innov 14(3):177–183
Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG (2008) The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilation. J Gastrointest Surg 12(1):159–165
Pandolfino JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ (2008) Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 135(5):1526–1533
Conflict of interest
The authors of this manuscript declare that they have no conflict of interest and that they did not receive financial supports by any company or organization for this study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Parise, P., Santi, S., Solito, B. et al. Laparoscopic Heller myotomy plus Dor fundoplication in 137 achalasic patients: results on symptoms relief and successful outcome predictors. Updates Surg 63, 11–15 (2011). https://doi.org/10.1007/s13304-011-0050-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-011-0050-2