Long-term functional results after laparoscopic surgery for esophageal achalasia

Tsiaoussis, John; Athanasakis, Elias; Pechlivanides, George; Tzortzinis, Anastasios; Gouvas, Nikolaos; Mantides, Apostolos; Xynos, Evaghelos

doi:10.1016/j.amjsurg.2006.10.008

« Previous Next »The American Journal of Surgery
Volume 193, Issue 1 , Pages 26-31, January 2007

Long-term functional results after laparoscopic surgery for esophageal achalasia

John Tsiaoussis, M.D., Ph.D.
- Gastrointestinal Motility Unit, Department of General Surgery, University Hospital of Heraklion, Heraklion, Crete, GR-711 10 Greece
Elias Athanasakis, M.D., Ph.D.
- Gastrointestinal Motility Unit, Department of General Surgery, University Hospital of Heraklion, Heraklion, Crete, GR-711 10 Greece
George Pechlivanides, M.D., Ph.D.
- 1st Surgical Department, Athens Naval and Veterans Hospital, Athens, Greece
Anastasios Tzortzinis, M.D.
- Surgical Department, Naval Hospital of Crete, Crete, Greece
Nikolaos Gouvas, M.D.
- Gastrointestinal Motility Unit, Department of General Surgery, University Hospital of Heraklion, Heraklion, Crete, GR-711 10 Greece
Apostolos Mantides, M.D., Ph.D.
- Gastroenterology Unit, Athens Naval and Veterans Hospital, Athens, Greece
Evaghelos Xynos, M.D., Ph.D., F.A.C.S.
- Gastrointestinal Motility Unit, Department of General Surgery, University Hospital of Heraklion, Heraklion, Crete, GR-711 10 Greece
- Corresponding author. Tel.: +00302810280002; fax: +00302810280009.

Received 30 December 2005; received in revised form 8 July 2006

Abstract

Background

Evidence on the long-term outcome of laparoscopic Heller–Dor surgery is limited. The aim of this study was to assess the long-term outcome of achalasic patients after surgery, particularly in relation to the radiologic preoperative stage of the disease.

Methods

Sixty-eight patients with achalasia were assessed clinically and by esophageal radiology, manometry, and 24-hour ambulatory esophageal pH monitoring before and at 3 months, 1, 1 to 3, 3 to 5, and 5 to 8 years after a laparoscopic Heller-Dor procedure.

Results

At 1 year after surgery the symptom score was significantly lower than the preoperative score (P < .001), and a satisfactory clinical outcome was seen in more than 90% of the patients with stage I, II, and III disease at the preoperative radiologic assessment. Only 50% of stage IV patients reported satisfactory results. An adequate opening of the lower esophageal sphincter (LES) and LES resting pressure of less than 8 mm Hg was achieved in all patients, and esophageal emptying was accelerated significantly (P < .001). At the consecutive follow-up evaluation (1–8 y), a satisfactory outcome was maintained in all stage I, II, and III responders. Stage IV patients with initially unsatisfactory results reported a worsening of symptoms (P < .02). Patients with pseudodiverticulum had a higher symptom score (P < .01). LES opening and resting pressure remained at levels of the 1-year follow-up evaluation. Esophageal emptying remained satisfactory in stage I, II, and III responders, but deteriorated in stage IV nonresponders and in 6 of the 10 patients with a pseudodiverticulum.

Conclusions

A satisfactory outcome of the laparoscopic Heller–Dor procedure in stage I, II, and III achalasic patients seems to last. Stage IV nonresponders tend to deteriorate over time. The development of pseudodiverticulum is associated with an increased symptom score.

Keywords: Esophageal achalasia, Laparoscopy, Heller Myotomy–Dor, Hemifundoplication, Long-term outcome, Esophageal emptying