Long-term results and influencing factors of laparoscopic Heller myotomy for achalasia
10.3760/cma.j.cn112434-20200604-00285
- VernacularTitle:经腹腔镜Heller肌切开治疗贲门失弛缓症的远期结果及影响因素
- Author:
Junfeng LIU
1
;
Xinbo LIU
;
Yan WANG
;
Xusheng SUN
;
Jihua WANG
;
Jiyun WANG
;
Haiyang LI
;
Guochen WANG
Author Information
1. 河北医科大学第四医院胸外科，石家庄 050011
- Keywords:
Achalasia;
Laparoscopic;
Heller myotomy;
Long-term results
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2021;37(11):654-659
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To assess the long-term outcome and influencing factors of laparoscopic Heller myotomy plus Dor fundoplication(LHM+ Dor) for achalasia by a single operator.Methods:Fifty-four patients who underwent LHM+ Dor consecutively from January 2011 to December 2019 were retrospectively reviewed. Those who had already undergone surgical or endoscopic myotomy and who were complicated with cancer were ruled out. Symptom inquiry and esophagogram were conducted both before and after surgery for assessing surgical results. Esophagoscopy, esophageal manometry and 24 h pH monitoring were performed before surgery, and the effects of these preoperative factors on the long-term outcome were analyzed.Results:All patients had dysphagia for average 6.5 years, ranging from 0.5-30.0 years. Intra-operative mucosal perforation occurred in 4(7.4%) patients, and there were no postoperative morbidity and mortality. At a median follow-up of 5.2 years, the morbidity of dysphagia decreased from 100% before surgery to 5.5% after surgery( P<0.001), Eckardt scores from 4.85±1.64 to 0.71±1.08( P=0.000). After surgery, 94.4% of patients had excellent and good relief of symptoms and good control of gastroesophageal reflux, the morbidity of heartburn being 3.7%. At 5 years after surgery, the probability of being symptoms free(Eckardt score≤1) was 91.7% in patients without preoperative night cough, compared to 54.6% in those with preoperative night cough( P=0.047). The probability was 92.3% in patients with grade Ⅰ and Ⅱ dilation of the esophagus and 79.0% in patients with grade Ⅲ and Ⅳ dilation( P=0.027). At multivariate analysis, heavier esophageal dilation was the independent predicator for poor symptom control after surgery. Conclusion:LHM+ Dor can be safely performed and durably relieve achalasia symptoms. Severe esophageal dilation before surgery is an independent predictor of a poor response to surgery.
