Laparoscopic Surgery for Achalasia; A Comparison of Heller-toupet and Heller-dor Procedures

Aims; Our aim of this study is to compare the short-term outcome of laparoscopic Heller-Toupet and Heller-Dor procedures for patients with achalasia from the symptomatic and functional points of view. Patients and Methods; Fifty-two patients with achalasia who complained dysphagia were enrolled into this study. All patients had laparoscopic Heller myotomy. The patients were divided into the following two groups according to the fundoplication type added to myotomy; Heller-Toupet group (HT, n=30) and Heller-Dor group (HD, n=22). The age was 41.8}11.8 years (mean}SD) in HT and 42.6}16.3 years in HD (NS; no significant difference). M/F ratio was 12/18 in HT and 11/11 in HD. The symptom and esophageal function were prospectively assessed on the basis of dysphagia score, esophagography and esophageal manometry before and after surgery. Results; The dysphagia score one year after surgery decreased to 1.7}1.2 points in HD, and 2.2}1.3 in HD from a preoperative value of 10. The change of the maximum transverse diameter of the esophagus on esophagography before and one year after surgery (before¨after) was 5.5}1.0¨3.8}1.1cm (pƒ0.01) in HT, and 4.3}1.0¨2.7}0.7cm (pƒ0.01) in HD. The change of LES pressure before and 3 months after surgery was 35.2}12.6¨15.0}6.7mmHg (pƒ0.01) in HT, and 38.4}13.7¨20.9}6.2mmHg (pƒ0.01) in HD. The LES pressure after surgery in HT was significantly lower than that in HD (pƒ0.01). The change of LES relaxation rate was 62.4}16.2¨81.5}9.7% (pƒ0.01) in HT, and 64.9}15.0¨78.5}10.7%(pƒ0.01) in HD. The change of lower esophageal body peristaltic pressure was 19.1}8.3¨19.5}11.3mmHg in HT (NS), and 30.5}13.3¨21.7}13.2mmHg in HD (NS). As postoperative sequelae, two patients(7%) in HT had esophageal diverticula, and two patients (9%) in HD had severe residual dysphagia which required endoscopic balloon dilation. Conclusions; Both laparoscopic HT and HD are useful procedures for reducing LES pressure, and relieving dysphagia in patients with achalasia. It is noted that HT rarely causes esophageal diverticula after surgery, and HD can cause severe residual dysphagia after surgery possibly due to relatively high residual LES pressure.

Session: Poster

Program Number: P321

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