Laparoscopic Heller myotomy is equally efficient and safe in patients who had pre-myotomy endoscopic interventions when compared with those with no interventions

Year 2017, Volume: 2 Issue: 1, 1 - 4, 16.04.2017

Zeynep Bilgi Adamu Issaka Hasan Fevzi Batırel

Abstract

Background:
Endoscopic treatment (ET) methods for achalasia such
as balloon dilatation and botulinum toxin injection has good success for short
and medium term management of achalasia. However some patients either need
repeat attempts or referred to surgery. In this study we analyzed and compared the
perioperative and disease specific quality of life outcomes of achalasia
patients who either underwent surgery as a first line treatment and the ones
who underwent ET method prior to surgery.

Materials and Methods: The patients who underwent standard of
care diagnostic workup and surgery for achalasia by the same surgical team
between 2007 and 2014 were recorded in a prospective database. The patients who
underwent surgery as a first line treatment (Group 1, n=55) and the patients
who underwent prior ET (Group 2, n=33) were identified. Demographic data,
peroperative complications, length of hospital stay, pre- and postoperative
Eckardt scores were recorded and analyzed.

Results:
A total of 88 patients out of 105 were available for
follow up with average follow up time of 61.9 ± 35.8 months. The mean age was
43.3 ± 15.6. Mean hospital stay was 2.3 ± 0.8 days and there was no mortality.
Average duration of the effectivity of ET before myotomy was 5.7 ± 7.7 months.
Peroperative complications not significantly accumulated in either group. Both
groups showed comparable drop in Eckardt scores.

Conclusions: Heller
myotomy and Dor fundoplication is a safe and durable option for treatment of
achalasia for both treatment naive patients and patients with previous repeated
ET modalities. 

Keywords

Achalasia, Heller myotomy, botulinum toxin, surgery

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