One-year follow-up after laparoscopic Heller-Dor operation for esophageal achalasia

摘要: Background: The Heller-Dor operation has recently been proposed for the treatment of esophageal achalasia even via a laparoscopic approach. Methods: To measure medium-term effectiveness this new minimally invasive technique, an evaluation pre- and postoperative symptoms, esophagogram, endoscopic findings, manometry, pH monitoring was prospectively designed in 43 patients with primary achalasia. mean clinical follow-up all is 12 months (range 3–43), while radiological 11 1–23). Endoscopic data 1 year after surgery are currently available 27 (63%), whereas 12-month 1–26) functional (including manometric pH-monitoring studies esophagus) 35 (81.4%). Results: No dysphagia reported 38 cases (88.4%); two (4.6%) complained occasional swallowing discomfort which regressed spontaneously; had persistent pneumatic dilatation. One patient (2.8%) mild 1-year asymptomatic period. Preoperatively, esophagograms showed average maximum diameter 40.6 ± 9.1 mm decreased to 24.1 6.0 operation. Mean lower sphincter (LES) resting residual pressures significantly from 28.6 10.7 mmHg 8.8 4.1 17.0 9.7 4.7 4.0 mmHg, respectively (p < 0.0001). These effects on LES function seem persist over time. complete absence any peristaltic contractions recorded preoperatively remained unchanged but four patients. However, rare recovery peristalsis proved be transient, revealed impairment their body function, without complaining dysphagia. Twenty-four-hour abnormal gastroesophageal reflux episodes (5.7%) who were monitored: one asymptomatic; other heartburn endoscopically demonstrated grade II esophagitis. Conclusions: Laparoscopic achieves excellent results which, together already-demonstrated advantages minimal surgical trauma rapid convalescence, validate use such approach treat esophagus.