Results after laparoscopic Heller-Dor operation for esophageal achalasia in 100 consecutive patients

Background: Laparoscopic Heller-Dor operation (LHD) has been the procedure of choice for the treatment of esophageal achalasia. However since, the incidence of achalasia is low, at one in 100,000 in USA and Japan, reports on the outcome of surgical treatment for such a disease are limited. In this study, we investigated the therapeutic results after LHD for achalasia at a single university hospital.
Methods: Between August 1994 and July 2006, a total of 100 consecutive patients (52 men and 48 women, mean age 41.9 years, range 9-82) underwent LHD in this period. The therapeutic results after LHD were assessed by peri- and post-operative complications, in terms of operation time, blood loss, post-operative hospital stay and standardized questionnaire for satisfaction (SQFS) by telephone or outpatient clinic interview.
Results: According to the pre-operative esophagogram, 66 patients (66%) had spindle-type achalasia, 24 patients (24%) had flask-type, and 13 patients (13%) had sigmoid-type. The severity of esophageal dilatation was assessed as grade I in 7 patients (7%), grade II in 66 patients (66%) and grade III in 27 patients (27%). As to peri-operative complications, the lower esophageal mucosal perforation occurred in 14 of the 100 patients (14%), but all of them could be suture-obliterated laparoscopically. One patient (1%) was converted to open surgery because of the uncontrolled bleeding from the short gastric artery. The mean operative time was 169 (range 110-240) min and mean peri-operative blood loss was 22 (range 0-1300) ml. Blood transfusion was required in one patient (1%). The median post-operative hospital stay was 7 (range 3-35) days. Reflux esophagitis was seen in 5 patients (5%), which was treated successfully with a proton pump inhibitor. The other 3 patients (3%) developed either acute dilatation of the stomach (2%) or atelectasis (1%), which were successfully treated by conservative management. According to the SQSF, 77 patients rated their recovery as gExcellenth, 17 as gGoodh, 4 as gFairh, and 2 as gPoorh, so that which resulted in the successful rate of 94%. On the other hand, post-operative pneumatic dilatation was required for 5 patients (5%) for inadequate improvement of dysphagia. In addition, re-operation was required for 2 patients (2%): one patient had intrathoracic wrap, which was repaired laparoscopically, and the other patient underwent subtotal esophagectomy for a curved upper esophagus.
Conclusion: Laparoscopic Heller-Dor operation is a safe and effective surgical treatment for esophageal achalasia.

Session: Podium Presentation

Program Number: S002