Laparoscopic Heller myotomy with Dor fundoplication for achalasia: long-term outcomes and effect on chest pain

Abstract

The aim of the present study was to evaluate the long-term outcomes of laparoscopic Heller myotomy with Dor fundoplication (LHD) and its effect on chest pain. Between June 1995 and August 2009, a total of 35 patients with achalasia underwent an LHD. The symptom scores were calculated by combining the frequency and the severity. Pre- and postoperative evaluations included symptom score, radiology, manometry, and 24-hour pH manometry. Median total symptom score was significantly lower than the preoperative score (19 vs 4, P < 0.001) at a median follow-up of 94 months. Among the 35 patients, 18 (51%) had chest pain. The frequency of chest pain was similar for the pre- and postoperative scores, but the severity tended to be less. Median esophageal diameter (5.4 cm vs 3.5 cm, P < 0.001) and lower esophageal sphincter pressure (41 mmHg vs 8.9 mmHg, P < 0.001) were significantly reduced after surgery. Median age, duration of symptoms, esophageal diameter, and lower esophageal sphincter pressure were similar between patients with and without chest pain prior to surgery. No significant differences were observed between the two groups in terms of amplitude, duration, and frequency of contractions from the findings of postoperative 24-hour esophageal manometry. Chest pain resolved in three patients (17%) and improved in seven patients (39%) after surgery. LHD can durably relieve achalasic symptoms of both dysphagia and regurgitation, and it can be considered the surgical procedure of choice. However, achalasic chest pain does not always seem to be related with patient characteristics and manometric findings.

The Outcome of Laparoscopic Surgery With and Without Short Gastric Vessel Division for Achalasia

“…15,16 However, as Table 3 shows, complete disappearance was observed in 11 cases (55%) in the SGVD (þ) group and 14 cases (54%) in the SGVD (À) group. The difference in the rate between the 2 groups did not differ significantly, because the improvement mainly depends on the myotomy, not on the fundopli- cation.…”

Single-incision laparoscopic heller myotomy and dor fundoplication for achalasia: Report of a case

“…15 We began using the LHD in 1995 and found that it produced a better outcome than the fundic patch operation, given its minimal invasiveness. 2,3 The laparoscopic procedure has progressed in recent years, 16 and operative procedures such as natural orifi ce transluminal endoscopic surgery (NOTES) 17 and SILAS 18,19 are reducing the degree of invasiveness even further. The SILAS procedure, in particular, has superior cosmetic and wound pain outcomes to conventional laparoscopic surgery, which requires that trocars be inserted from several sites.…”

“…1 We began performing laparoscopic Heller myotomy and Dor fundoplication (LHD) in 1995, with favorable therapeutic outcomes for both dysphagia and regurgitation. 2,3 Single-incision laparoscopic access surgery (SILAS) has since reduced the invasiveness of laparoscopic surgery even further by requiring fewer access ports, and it has consequently also reduced the degree of pain and complications associated with their use. 4 SILAS is now the subject of much interest throughout the world.…”

Single-port laparoscopic Heller myotomy and Dor fundoplication: initial experience with a new approach for the treatment of pediatric achalasia

“…In 1995, we started using a laparoscopic approach for Heller myotomy and Dor fundoplication in adults with achalasia, and favorable therapeutic outcomes have been obtained with relief of dysphagia and regurgitation [7]. Our team has also recently performed successful nephrectomy, Nissen fundoplication, appendectomy, and inguinal hernioplasty in children using SPLS.…”