ESOPHAGEAL ACHALASIA - LAPAROSCOPIC VERSUS CONVENTIONAL OPEN HELLER-DOR OPERATION

BACKGROUND: The laparoscopic treatment of esophageal achalasia has rec ently been introduced, and the occasional reports in the literature se em to indicate considerable advantages for patients in terms of surgic al trauma, postoperative discomfort, and appearance, As yet, however, no studies have directly analyzed the benefits and shortcomings of the new surgical technique by comparison with the conventional open proce dure, The objective of our study was to review recent experience with the laparoscopic Heller-Dor operation (LAP-HD) at the Department of Su rgery of Padua University and compare it with the traditional open Hel ler-Dor procedure (OPEN-HD) to assess early effectiveness in patients with primary esophageal achalasia. PATIENTS AND METHODS: The records o f 17 patients who had LAP-HD and a matched group of 17 patients who ha d OPEN-HD were retrospectively reviewed, The duration of procedures, m orbidity, several aspects of the postoperative course, and hospital co sts were recorded and compared, Results of clinical follow-up and of m anometric and pH-monitoring studies performed 6 months postoperatively were also evaluated in both patient groups, RESULTS: LAP-HD took long er than OPEN-HD (mean 178 versus 125 minutes), There was no mortality or major morbidity in either group, Postoperative pain and ileus and n eed for IV nutrition lasted a shorter time for LAP-HD patients (P < 0. 0001). Consequently, the median postoperative hospital stay and the me dian interval before returning to normal activity were also shorter (4 and 14 days for the LAP-HD group versus 10 and 30 days for the OPEN-H D group, P < 0.0001). During follow-up, dysphagia recurred in 1 patien t of the LAP-HD group and gastroesophageal reflux was registered in 1 patient of the OPEN-HD group. Lower esophageal sphincter pressure decr eased significantly after both procedures. CONCLUSIONS: Laparoscopic m anagement of achalasia leads to short-term results comparable to those of the well-established open technique, In view of the less severe su rgical trauma and lower hospital cost, the laparoscopic approach is pr eferable, but long-term studies are needed.