Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience

Abstract

Background/Aim: Laparoscopic Heller myotomy with Dor fundoplication (LHD) is a widely used surgical method in achalasia treatment. However, it has not been well studied in terms of symptomatic relief effect and anti-reflux success in the long term. This study aimed to investigate the long-term success of LHD on symptom relief and acid reflux control. Methods: Patients who underwent LHD between February 2011 and June 2020 were included in this retrospective cohort study. Patients' demographics, post-operative follow-up outcomes and esophagitis signs on endoscopy were retrieved from the institutional database. Eckardt scores of all study patients were calculated. Those with insufficient follow-up data were excluded. Disease free rates were calculated using the Kaplan-Meier analysis. Results: A total of 24 patients, 11 males and 13 females, were included. The mean age of all patients was 47.9 (11.3) years. The median follow-up time was 71.0 (12.0-117.0) months. Cumulative symptomatic relief (Eckardt ≤3) rate of LHD was 87.5% (21/24). Kaplan-Meier analysis showed that the timedependent probability of Eckardt score being ≤3 at 3 and 5 years after the surgery were 100% and 94.7%, respectively. The mean expected survival time with Eckardt score ≤3 was 102.5 (95% CI: 87.6-117.3) months. The post-LHD esophagitis rate was 20.8% (5/24). The probability of no reflux esophagitis at 3 and 5 years after the surgery were 95.0% and 89.4%, respectively. The mean expected esophagitis-free survival was 94.2 (95% CI: 80.6-107.7) months. Conclusion: LHD seems successful and safe in terms of long-term symptomatic relief and acid reflux control in the surgical treatment of achalasia.