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Possible Factors Predicting Outcome

George Pechlivanides, MD,PhD; Emmanuel Chrysos, MD,PhD; Elias Athanasakis, MD; John Tsiaoussis, MD,PhD; John Sophocles Vassilakis, MD,PhD; Evaghelos Xynos, MD,PhD,FACS

Arch Surg. 2001;136:1240-1243.

Hypothesis  Laparoscopic Heller myotomy with anterior hemifundoplication is the surgical procedure of choice for the treatment of esophageal achalasia. Specific factors, eg, severity of esophageal body deformity, might affect postoperative outcome.

Design  Prospective case-control study.

Setting  Academic referral center for gastrointestinal tract motility disorders.

Patients  Twenty-nine patients with esophageal achalasia who underwent 1 to 3 sessions of failed pneumatic dilation each.

Intervention  Laparoscopic Heller myotomy with anterior (Dor) hemifundoplication.

Main Outcome Measures  Preoperative and postoperative symptomatic evaluation, esophagoscopy, esophagography, stationary and ambulatory esophageal manometry, and pH monitoring.

Results  Three patients had stage I disease, 10 had stage II, 12 had stage III, and 4 had stage IV at preoperative radiologic examination. At surgery, there were no conversions to open procedures, and 2 mucosal perforations were immediately identified and sutured. Good or excellent results were seen in 26 patients. All patients with stage I or II disease had excellent functional results. Of patients with stage III disease, results were excellent in 7, good in 4, and bad in 1. Of patients with stage IV disease, 2 had good results and 2 had bad results. After surgery, lower esophageal sphincter pressure was reduced significantly (from 46.1 ± 12.1 to 5.4 ± 1.8 mm Hg; P<.001), as was esophageal diameter (from 61 ± 17 to 35 ± 19 mm; P<.001) (data are given as mean ± SD). However, an excellent result occurred only in patients with a postoperative esophageal diameter less than 40 mm.

Conclusion  Functional outcome of laparoscopic Heller-Dor procedure for achalasia is related to the preoperative stage of the disease on the esophagogram and to the extent of reduction in esophageal width after surgery.

From the Laboratory of Gastrointestinal Motility and the Department of General Surgery, University Hospital of Heraklion, Crete, Greece.

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