Laparoscopie Heller-Dor for primary esophagus achalasia. Outcomes in 173 patients

  • Rosati R
  • Romano U
  • Ceolin M
 et al. 
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Abstract

AIM: Laparoscopic Heller myotomy combined with anterior (Dor) fundoplication is the most widely-used surgical procedure for treating esophageal achalasia in Europe, MATERIAL OF STUDY: From November 1992 through May 2010 we performed laparoscopic Heller-Dor on 173 patients, RESULTS: Conversion to laparotomy was required in three cases (1.7%) at the beginning of the experience (for mucosal) perforation which was the most frequent intraoperative complication, managed laparoscopically with the increasing experience. Five (2.9%) cases had minor postoperative complications. Clinical results were satisfactory in 99.4% of cases. One patient (0.6%) had severe persistent dysphagia. Mean esophageal diameter decreased from 50 mm +/- 12 (range 20- 90) to 25 mm +/- 7 (range 15-80). Lower esophageal sphincter pressure decreased from 32 mmHg (median, range 10- 93) pre-operatively to 11 mmHg (median, range 5-21) at one year follow up and residual pressure from 12 mmHg (median, range 3-30) to 4 mmHg (median, range 1-8). Impedance and pH monitoring showed normal levels in 39/47 (83%) patients who agreed to testing., CONCLUSION: The good outcomes of this experience, in part due to careful adherence to technical aspects of the operation, confirm that the laparoscopic Heller-Dor is the gold standard surgical treatment for esophageal achalasia.

Author-supplied keywords

  • Achalasia
  • Dor fundoplication
  • Laparoscope Heller myotomy

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  • SGR: 84893279403
  • PMID: 24141366
  • PUI: 372265013
  • SCOPUS: 2-s2.0-84893279403
  • ISSN: 0003469X

Authors

  • Riccardo Rosati

  • Uberto Fumagalli Romano

  • Martina Ceolin

  • Simonetta Massaron

  • Alberto Peracchia

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