Outcome predictors of laparoscopic Heller-Dor fundoplication for achalasia

Outcome of laparoscopic Heller-Dor procedure for achalasia is related to both the preoperative stage of the disease on esophagogram, and to the extent of reduction in esophageal width after surgery, finds a study published in November's Archives of Surgery.

Laparoscopic Heller myotomy with anterior hemifundoplication is the surgical procedure of choice for the treatment of esophageal achalasia.

Specific factors, such as severity of esophageal body deformity, may however affect postoperative outcome.

In a prospective, case-control study, researchers from the University Hospital of Heraklion, Crete, Greece, investigated whether such factors could be used as predictors of the outcome of this procedure.

A total of 29 patients with esophageal achalasia were recruited into the study. Each subject had undergone 1 to 3 sessions of failed pneumatic dilation.

Laparoscopic Heller myotomy with anterior (Dor) hemifundoplication was performed in each patient.

Preoperative and postoperative symptomatic evaluation, esophagoscopy, esophagography, stationary and ambulatory esophageal manometry, and pH monitoring were also conducted.

At preoperative radiologic examination, the research group identified 3 patients with stage I disease, 10 with stage II, 12 with stage III, and 4 with stage IV disease.

At surgery, there were no conversions to open procedures, and 2 mucosal perforations were immediately identified and sutured.

Outcome predictors: - Preoperative achalasia stage - Postoperative esophageal width reduction

Archives of Surgery

Good or excellent results were seen in 26 patients. All patients with stage I or II disease had excellent functional results.

Of the patients with stage III disease, results were excellent in 7, good in 4, and bad in 1. In patients with stage IV disease, 2 had good results and 2 had bad results.

After surgery, lower esophageal sphincter pressure was reduced significantly (from 46.1 to 5.4 mm Hg), as was esophageal diameter (from 61 to 35).

However, an excellent result occurred only in patients with a postoperative esophageal diameter less than 40 mm.

Dr George Pechlivanides commented on behalf of his fellow authors that the functional outcome of laparoscopic Heller-Dor procedure for achalasia was shown to be related to both the preoperative stage of the disease on the esophagogram, and to the extent of reduction in esophageal width after surgery.