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Over ten-year outcomes of laparoscopic Heller-myotomy with Dor-fundoplication with achalasia: single-center experience with annual endoscopic surveillance

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Abstract

Background

Laparoscopic Heller-myotomy with Dor-fundoplication (LHD) is the standard surgical treatment for achalasia; however, surgical outcomes over a period greater than 10 years have not been well-explored. The objective of this study was to evaluate the long-term outcomes of LHD for achalasia based on a single-center experience.

Methods

Patients who underwent LHD between 1994 and 2019 were included. Of these, we excluded patients who had undergone foregut surgery or whose follow-up data were unavailable. Esophagogastroduodenoscopy (EGD) findings and postoperative persistent and/or recurrent symptoms had been assessed annually. Disease-free rates were calculated using Kaplan–Meier analysis.

Results

A total of 530 patients (mean age 45.0 years with 267 men) were included. The median follow-up period was 50.5 months. More than 10 years’ data were available in 78 patients (14.7%). The cumulative rates of freedom from dysphagia, vomiting, chest pain, and Eckardt score > 3 at 10 years after LHD were 80.1%, 97.5%, 96.3%, and 73.5%, respectively. Probability of esophagitis during 10 years after surgery was 34.4% of patients based on Kaplan–Meier estimation. Approximately 3/4th of patients who had post-LHD esophagitis showed mild esophagitis of Los Angeles classification grade A. Fifteen patients (2.8%) were required a revision of primary LHD. Six patients (1.2%) developed esophageal cancer with an incidence was as high as 219.8/100,000 person-year. All patients with esophageal cancer were found to have early stage tumors that were successfully resected.

Conclusions

Symptomatic relief post-LHD lasted for over 10 years. The incidence rate of esophageal cancer was high. Regular EGD surveillance seems to be helpful for early detection of esophageal cancer early.

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Abbreviations

aSg:

Advanced sigmoid

BMI:

Body mass index

EGD:

Esophagogastroduodenoscopy

HRM:

High-resolution manometry

JES:

Japan Esophageal Society classification

LES:

Lower esophageal sphincter

LHD:

Laparoscopic Heller-myotomy with Dor-fundoplication

LHM:

Laparoscopic Heller-myotomy

POEM:

Peroral endoscopic myotomy

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Authors and Affiliations

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

    Naoko Fukushima, Takahiro Masuda, Fumiaki Yano, Nobuo Omura, Kazuto Tsuboi, Masato Hoshino, Se Ryung Yamamoto, Shunsuke Akimoto, Yuki Sakashita, Norio Mitsumori, Hideyuki Kashiwagi & Toru Ikegami

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  1. Naoko Fukushima
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  2. Takahiro Masuda
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  3. Fumiaki Yano
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Correspondence to Naoko Fukushima.

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Drs. Naoko Fukushima, Takahiro Masuda, Fumiaki Yano, Nobuo Omura, Kazuto Tsuboi, Masato Hoshino, Se Ryung Yamamoto, Shunsuke Akimoto, Yuki Sakashita, Norio Mitsumori, Hideyuki Kashiwagi and Toru Ikegami have no conflicts of interest or financial ties to disclose.

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Fukushima, N., Masuda, T., Yano, F. et al. Over ten-year outcomes of laparoscopic Heller-myotomy with Dor-fundoplication with achalasia: single-center experience with annual endoscopic surveillance. Surg Endosc 35, 6513–6523 (2021). https://doi.org/10.1007/s00464-020-08148-5

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