Outcomes of laparoscopic surgery for esophageal achalasia in 374 patients

F Yano, MD, PhD, FACS, N Omura, MD, PhD, K Tsuboi, MD, PhD, M Hoshino, MD, S R Yamamoto, MD, S Akimoto, MD, N Mitsumori, MD, PhD, Y Ishibashi, MD, PhD, K Nakada, MD, PhD, K Kashiwagi, K Yanaga, MD, PhD, FACS

Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan

Introduction: Laparoscopic Heller-Dor (LHD) surgery has become the procedure of choice for the treatment of achalasia. However, the incidence of achalasia is extremely low, and reports on the outcome of surgical treatment are limited. In this study, outcomes of LHD for achalasia in 374 patients at a single institution were evaluated.

Methods: Three-hundred and seventy-four patients underwent surgical treatment of LHD (20 reduced port surgeries were included) for achalasia between August 1994 and June 2012. There were 195 men (52%) and 179 women (48%). Their mean age was 44.7 (range, 9-83) years. Their clinical data were collected in a prospectively fashion and retrospectively reviewed. The therapeutic effects of LHD were assessed in terms of operation time, blood loss, perioperative complications, postoperative hospital stay, incidence of postoperative reflux esophagitis, and frequency of reoperation.

Results: No operative mortality occurred. The mean operation time was 170.1±45.2 (range 67-447) minutes and the median intraoperative blood loss was 0 (range 0-1,300) ml. Perioperative complications occurred in 73 (20%) patients, consisting of injuries of the esophagus and/or gastric mucosa, vagal nerve, pyriform fossa, small intestine, or spleen. One patient (0.3%) who had splenic injury required conversion to open surgery. The median postoperative hospital stay was 4 (range 3-35) days. Postoperative reflux esophagitis occurred in 27 (7%) patients and 6 other patients (2%) required pneumatic dilation because of postoperative stenosis. Three (1.5%) patients required re-do surgery for dislocation of the wrap and perforation of the small intestine which was not identified intraoperatively. Postoperative questionnaire was available in 292 of 374 patients (78%). Most patients reported a high degree of satisfaction with surgery. The mean score (highest point: 5) was 4.7±0.7 (range 1-5).

Conclusion: Perioperative complications occurred in 20% but these were not severe, and the incidence of convert to open surgery was as low as 0.3%. LHD is a safe and secure procedure for treatment of achalasia.

Session: Poster Presentation

Program Number: P598

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