Kazuto Tsuboi, MD1, Nobuo Omura, MD2, Fumiaki Yano, MD3, Masato Hoshino, MD3, Se-Ryung Yamamoto3, Shunsuke Akimoto, MD3, Takahiro Masuda3, Hideyuki Kashiwagi, MD1, Norio Mitsumori, MD3, Katsuhiko Yanaga, MD3. 1Fuji City General Hospital, Shizuoka, Japan, 2Nishisaitama-Chuo National Hospital, Saitama, Japan, 3The Jikei University School of Medicine, Tokyo, Japan
Background: Esophageal achalasia is one of the primary esophageal motility disorders, and the patients suffer from dysphagia, vomiting and chest pain. Timed barium esophagogram (TBE) is a convenient method to assess esophageal clearance, which we usually performed before and after surgery. Meanwhile, laparoscopic Heller-Dor operation (LHD) has been considered worldwide as a gold standard for the surgical management of esophageal achalasia. The aim of this study is to examine the effect of preoperative clearance rate at the lower part of the esophagus on surgical outcomes in patients with esophageal achalasia.
Patients and Method: Between August 1994 to April 2017, patients who underwent LHD at our institution were extracted from the database. Out of 557 patients, 398 patients met our inclusion criteria; such as the patients who underwent LHD as an initial operation with complete evaluation with preoperative esophageal clearance by TBE. These patients were divided into three groups by the degree of esophageal clearance (Group A: clearance rate < 10%, Group B: 10%?clearance rate < 50%, and Group C: 50%?clearance rate). Patients’ background, pre- and post-operative symptom scores, and surgical results were compared. Before and after surgery, the standardized questionnaire was used to assess the degree of frequency and severity of symptoms (dysphagia, vomiting, chest pain and heartburn). Moreover, satisfaction with operation was evaluated using the standardized questionnaire. Statistical analysis was performed by using Krasukal- Wallis test or chi-square test, and p-value less than 0.05 was defined as statistically different.
Results: Their mean age was 44.3 years and 204 of them were male (51.3%). One hundred and sixty-eight patients (42.2%) were in Group A, 149 (37.4%) in Group B, and 81(20.4%) in Group C. The maximum width of the esophagus in Group C was smaller than that in other groups (p=0.0258). As to the pre-operative symptom score, the frequency score of dysphagia was significantly lower in Group C (p=0.026), whereas the severity score of chest pain was significantly higher in Group C (p=0.0465). Surgical outcomes including the incidence of mucosal injury were not different among the groups. Moreover, the patient satisfaction with LHD was excellent regardless of preoperative esophageal clearance.
Conclusion: Preoperative clearance rate at the lower part of the esophagus in patients with esophageal achalasia did not affect the surgical outcomes of LHD, but the characteristics of preoperative symptoms in patients with poor esophageal clearance was low dysphagia and high chest pain.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 85109
Program Number: P458
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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