ONE-YEAR FOLLOW-UP AFTER LAPAROSCOPIC HELLER-DOR OPERATION FOR ESOPHAGEAL ACHALASIA

Background: The Heller-Dor operation has recently been proposed for th e treatment of esophageal achalasia even via a laparoscopic approach. Methods: To measure the medium-term effectiveness of this new minimall y invasive technique, an evaluation of pre- and postoperative symptoms , esophagogram, endoscopic findings, esophageal manometry, and pH moni toring was prospectively designed in 43 patients with primary esophage al achalasia. The mean clinical follow-up for all the patients is 12 m onths (range 3-43), while the mean radiological follow-up is 11 months (range 1-23). Endoscopic data 1 year after surgery are currently avai lable for 27 patients (63%), whereas a 12-month (range 1-26) functiona l followup (including manometric and pH-monitoring studies of the esop hagus) is currently available for 35 patients (81.4%). Results: No dys phagia was reported in 38 cases (88.4%); two (4.6%) complained of occa sional swallowing discomfort which regressed spontaneously; two (4.6%) had persistent dysphagia which regressed with pneumatic dilatation. O ne patient (2.8%) reported mild occasional dysphagia after a 1-year as ymptomatic period. Preoperatively, esophagograms showed an average max imum diameter of 40.6 +/- 9.1 mm which decreased to 24.1 +/- 6.0 mm af ter operation. Mean lower esophageal sphincter (LES) resting and resid ual pressures decreased significantly from 28.6 +/- 10.7 mmHg to 8.8 /- 4.1 mmHg and from 17.0 +/- 9.7 mmHg to 4.7 +/- 4.0 mmHg, respective ly (p < 0.0001). These effects on esophageal diameter and LES function seem to persist over time. The complete absence of any peristaltic co ntractions recorded preoperatively in all cases remained unchanged aft er surgery in all but four patients. However, this rare recovery of pe ristalsis proved to be transient, and patients revealed a manometric i mpairment of their esophageal body function, but without complaining o f dysphagia. Twenty-four-hour pH monitoring showed abnormal gastroesop hageal reflux episodes in two (5.7%) of the 35 patients who were monit ored: one was asymptomatic; the other had heartburn and endoscopically demonstrated grade II esophagitis. Conclusions: Laparoscopic Heller-D or operation achieves excellent medium-term results which, together wi th the already-demonstrated advantages of a minimal surgical trauma an d rapid convalescence, validate the use of such a minimally invasive a pproach to treat patients with primary achalasia of the esophagus.