LONG TERM RESULTS OF LAPAROSCOPIC HELLER MYOTOMY IN 25 PATIENTS WITH ACHALASIA

B Perreault, S Langevin, J Ledoux

Departement de medecine et de chirurgie, Université de Sherbrooke, Sherbrooke, Québec

BACKGROUND: The advent of laparoscopic surgery has provided a minimally invasive approach for the treatment of patient with achalasia, making surgery a more attractive option as the initial treatment. Short term outcomes are promising but data about long term follow-up are restricted.
AIMS: The purpose of this retrospective study was to assess the long term results of laparoscopic Heller myotomy and partial antireflux procedure (LHMPA). Post-operative reflux symptoms and dysphagia were specifically assessed.
METHODS: Since 1993, 25 consecutive patients submitted to a LHMPA were included in this study. In 16 patients, laparoscopic surgery was the first line therapy. The diagnosis of achalasia was based on endoscopic, radiographic and manometric findings. Patients were interviewed by telephone during summer 2002. Symptoms related to esophageal and GERD were evaluated according to a semi quantitative scale. Medical records and surgery reports were both reviewed.
RESULT: They were 14 males and 11 females whose ages ranged from 20 to 74 years with a mean age of 46.3 years. Complete follow-up was obtained in 16 patients. 6 patients were lost to follow-up and 3 patient died. The mean follow-up was 48 months (10-92). 15 patients were considered to be in clinical remission according to Eckard grading scale. Only 2 patients needed medical treatment for GERD symptoms. A total of 4 complications was observed in the immediate post operative time (4/25 patients). A second surgery was required in two patients, one patient with a post operative gastric herniation and the other for severe dyphagia. The other two complications were esophageal leak and post operative infection, treated conservatively with uneventful course. There were no operative death.
CONCLUSION: Laparoscopic Heller myotomy with antireflux procedure is a safe and effective treatment for achalasia with excellent long term results. Laparoscopic approach appear as the preferred initial treatment to uncomplicated achalasia. Both manometric and 24-hours pH study are planed in these patients.