Comparison between outcome after laparoscopic Heller’s myotomy with Dor fundoplication in patients who had or had not undergone previous trials of endoscopic balloon dilatation for cardiac achalasia

El Fiky, Khaled Abdallah; El Akkad, Hisham Abdel Raouf; Mohamed, Mohamed Mahfouz; Gerges, Wadie Boshra; Mikhail, Fadi Hani Wahba

doi:10.4103/ejs.ejs_193_21

Comparison between outcome after laparoscopic Heller’s myotomy with Dor fundoplication in patients who had or had not undergone previous trials of endoscopic balloon dilatation for cardiac achalasia

Authors

Abstract

Aim
The aim of this study is to assess the effect of prior endoscopic balloon dilatation on the outcome of laparoscopic Heller’s cardiomyotomy with Dor fundoplication (DF) for treatment of cardiac achalasia.
Patients and methods
This study was conducted over 20 patients who underwent laparoscopic Heller’s cardiomyotomy with DF between January 2018 and December 2020 in Ain Shams University Hospitals. These patients were divided into two groups: the first group included patients who underwent Heller’s cardiomyotomy with DF with previous once or multiple failed sessions of balloon dilatation [pneumatic balloon dilatation (PBD) group]. The second group included patients who underwent Heller’s cardiomyotomy with DF without previous balloon dilatation (non-PBD group). Each patient was seen for follow-up after 6 months. Preoperative and postoperative achalasia symptoms, including weight loss, dysphagia, heartburn, and regurgitation, were evaluated using the Eckardt score.
Results
When patients were compared according to whether they underwent preoperative endoscopic PBD or not, there was no significant difference in terms of age, sex, preoperative lower esophageal sphincter pressure, hospitalization period, and complications. Operative time had a statistically significant difference between the two groups of patients. The mean Eckardt score measured at 6 months postoperative was significantly lower than the preoperative Eckardt score (0.55±0.69 vs. 4.45±1.36, <0.001). In contrast, there was no significant difference in the preoperative and postoperative Eckardt scores between patients who underwent preoperative endoscopic PBD and those who did not (pre was =0.637 and post was =0.404).
Conclusion
Laparoscopic Heller–Dor surgery is an effective procedure in relieving achalasia symptoms as a first-line therapy as well as in individuals with repeated previous endoscopic PBDs. Patients with previous PBDs (the PBD group) had a longer operative time with increased difficulty of dissection due to fibrosis and adhesions.

Keywords