Previous esophageal dilatation as a risk factor for mucosal injury during laparoscopic Heller myotomy for achalasia

Background
Esophageal achalasia is an esophageal-motility disorder of unknown etiology that results in impaired relaxation of the lower esophageal sphincter and loss of esophageal peristalsis. Achalasia can be primary (idiopathic) or secondary. In secondary achalasia, the cause for the degeneration of esophageal nerve fibers is known. Pathophysiologically, achalasia is caused by loss of inhibitory ganglion cells in the myenteric plexus. Several studies have attempted to explore initiating agents that may cause the disease such as viral infection, other environmental factors, autoimmunity, and genetic factors. However, the exact pathogenesis of primary achalasia is still not known.
Aim
The aim of the study is to assess esophageal dilatation before surgery as a risk factor for esophageal mucosal injuries during laparoscopic Heller’s cardiomyotomy.
Patients and methods
This prospective study was performed on a total of 20 patients who diagnosed with esophageal achalasia undergoing Heller’s cardiomyotomy and willing to participate in the study at Tertiary Care Hospital at Ain Shams University Hospitals from July 2019 to June 2021 with inclusion and exclusion criteria.
Results
There was no statistically significant difference among the studied groups regarding type of achalasia and preoperative lower esophageal sphincter pressure. There was significant higher operative time among previous-dilatation group than the no-previous-dilatation group with no statistically significant difference among the studied groups regarding postoperative wound infection, intraoperative bleeding, and postoperative hospital stay. There was no statistically significant difference among the studied groups regarding postoperative-reflux esophagitis and perforation. Our results revealed a highly significant difference between the preoperative and postoperative Eckardt scores among the same group with value of 0.007 in the no-previous-dilatation group and value of 0.003 in the previous-dilatation group, while there was no statistically significant difference found between the studied groups regarding preoperative and postoperative Eckardt scores.
Conclusion
As evident from the study, previous esophageal dilatation is not a risk factor for mucosal injury during laparoscopic Heller myotomy for achalasia. Laparoscopic Heller’s cardiomyotomy achieved symptomatic improvement in all patients, regardless of prior pneumatic balloon dilation, and preoperative pneumatic balloon dilation did not affect the incidence of residual symptoms, necessity of additional postoperative treatments, occurrence of symptomatic gastroesophageal reflux disease, or intraoperative mucosal perforation.