Complex surgical treatment of oesophageal achalasia in the era of minimally invasive surgery: short- and long-term results
EAES Academy. Andrási L. 07/05/22; 363182; P227
László Andrási
Contributions
Contributions
Abstract
Aims:
We have analysed the short- and long-term results of various surgical therapies for achalasia, especially changes in postoperative oesophageal function.
Methods:
Between 2008 and 2020, 69 patients with oesophageal achalasia were treated in our institution. Patients scheduled for surgery underwent a comprehensive gastroenterological assessment pre- and post-surgery. Sixy-three of the elective cases involved a laparoscopic cardiomyotomy with Dor’s semifundoplication, while two cases entailed an oesophageal resection with an intrathoracic gastric replacement for end-stage achalasia. Torek’s operation was performed on two patients for iatrogenic oesophageal perforation, and two others underwent primary suture repair with Heller–Dor surgery as an emergency procedure. The results of the different surgical treatments, as well as changes in the patients’ pre- and postoperative complaints were evaluated.
Results:
No intraoperative complications were observed, and no mortalities resulted. During the 12–24-month follow-up period, recurrent dysphagia was observed mostly in the spastic group (TIII: 40%; diffuse oesophageal spasm: 60%), while its occurrence in the TI type did not change significantly (12.1% - 9.7%). As a result of the follow-up of more than two years, good symptom control was achieved in 95.1% of the patients, with only three patients (4.7%) developing postoperative reflux.
Conclusions:
The laparoscopic Heller–Dor procedure provides satisfactory long-term results with low morbidity. In emergency and advanced cases, traditional surgical procedures are still the recommended therapy.
We have analysed the short- and long-term results of various surgical therapies for achalasia, especially changes in postoperative oesophageal function.
Methods:
Between 2008 and 2020, 69 patients with oesophageal achalasia were treated in our institution. Patients scheduled for surgery underwent a comprehensive gastroenterological assessment pre- and post-surgery. Sixy-three of the elective cases involved a laparoscopic cardiomyotomy with Dor’s semifundoplication, while two cases entailed an oesophageal resection with an intrathoracic gastric replacement for end-stage achalasia. Torek’s operation was performed on two patients for iatrogenic oesophageal perforation, and two others underwent primary suture repair with Heller–Dor surgery as an emergency procedure. The results of the different surgical treatments, as well as changes in the patients’ pre- and postoperative complaints were evaluated.
Results:
No intraoperative complications were observed, and no mortalities resulted. During the 12–24-month follow-up period, recurrent dysphagia was observed mostly in the spastic group (TIII: 40%; diffuse oesophageal spasm: 60%), while its occurrence in the TI type did not change significantly (12.1% - 9.7%). As a result of the follow-up of more than two years, good symptom control was achieved in 95.1% of the patients, with only three patients (4.7%) developing postoperative reflux.
Conclusions:
The laparoscopic Heller–Dor procedure provides satisfactory long-term results with low morbidity. In emergency and advanced cases, traditional surgical procedures are still the recommended therapy.
Aims:
We have analysed the short- and long-term results of various surgical therapies for achalasia, especially changes in postoperative oesophageal function.
Methods:
Between 2008 and 2020, 69 patients with oesophageal achalasia were treated in our institution. Patients scheduled for surgery underwent a comprehensive gastroenterological assessment pre- and post-surgery. Sixy-three of the elective cases involved a laparoscopic cardiomyotomy with Dor’s semifundoplication, while two cases entailed an oesophageal resection with an intrathoracic gastric replacement for end-stage achalasia. Torek’s operation was performed on two patients for iatrogenic oesophageal perforation, and two others underwent primary suture repair with Heller–Dor surgery as an emergency procedure. The results of the different surgical treatments, as well as changes in the patients’ pre- and postoperative complaints were evaluated.
Results:
No intraoperative complications were observed, and no mortalities resulted. During the 12–24-month follow-up period, recurrent dysphagia was observed mostly in the spastic group (TIII: 40%; diffuse oesophageal spasm: 60%), while its occurrence in the TI type did not change significantly (12.1% - 9.7%). As a result of the follow-up of more than two years, good symptom control was achieved in 95.1% of the patients, with only three patients (4.7%) developing postoperative reflux.
Conclusions:
The laparoscopic Heller–Dor procedure provides satisfactory long-term results with low morbidity. In emergency and advanced cases, traditional surgical procedures are still the recommended therapy.
We have analysed the short- and long-term results of various surgical therapies for achalasia, especially changes in postoperative oesophageal function.
Methods:
Between 2008 and 2020, 69 patients with oesophageal achalasia were treated in our institution. Patients scheduled for surgery underwent a comprehensive gastroenterological assessment pre- and post-surgery. Sixy-three of the elective cases involved a laparoscopic cardiomyotomy with Dor’s semifundoplication, while two cases entailed an oesophageal resection with an intrathoracic gastric replacement for end-stage achalasia. Torek’s operation was performed on two patients for iatrogenic oesophageal perforation, and two others underwent primary suture repair with Heller–Dor surgery as an emergency procedure. The results of the different surgical treatments, as well as changes in the patients’ pre- and postoperative complaints were evaluated.
Results:
No intraoperative complications were observed, and no mortalities resulted. During the 12–24-month follow-up period, recurrent dysphagia was observed mostly in the spastic group (TIII: 40%; diffuse oesophageal spasm: 60%), while its occurrence in the TI type did not change significantly (12.1% - 9.7%). As a result of the follow-up of more than two years, good symptom control was achieved in 95.1% of the patients, with only three patients (4.7%) developing postoperative reflux.
Conclusions:
The laparoscopic Heller–Dor procedure provides satisfactory long-term results with low morbidity. In emergency and advanced cases, traditional surgical procedures are still the recommended therapy.
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