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Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience

Year 2021, Volume: 5 Issue: 9, 937 - 940, 01.09.2021

Ali Sürmelioğlu Doğukan Akkuş

https://doi.org/10.28982/josam.981343

Abstract

Background/Aim: Laparoscopic Heller myotomy with Dor fundoplication (LHD) is a widely used surgical method in achalasia treatment. However, it has not been well studied in terms of symptomatic relief effect and anti-reflux success in the long term. This study aimed to investigate the long-term success of LHD on symptom relief and acid reflux control.
Methods: Patients who underwent LHD between February 2011 and June 2020 were included in this retrospective cohort study. Patients’ demographics, post-operative follow-up outcomes and esophagitis signs on endoscopy were retrieved from the institutional database. Eckardt scores of all study patients were calculated. Those with insufficient follow-up data were excluded. Disease free rates were calculated using the Kaplan-Meier analysis.
Results: A total of 24 patients, 11 males and 13 females, were included. The mean age of all patients was 47.9 (11.3) years. The median follow-up time was 71.0 (12.0-117.0) months. Cumulative symptomatic relief (Eckardt ≤3) rate of LHD was 87.5% (21/24). Kaplan-Meier analysis showed that the time-dependent probability of Eckardt score being ≤3 at 3 and 5 years after the surgery were 100% and 94.7%, respectively. The mean expected survival time with Eckardt score ≤3 was 102.5 (95% CI: 87.6-117.3) months. The post-LHD esophagitis rate was 20.8% (5/24). The probability of no reflux esophagitis at 3 and 5 years after the surgery were 95.0% and 89.4%, respectively. The mean expected esophagitis-free survival was 94.2 (95% CI: 80.6-107.7) months.
Conclusion: LHD seems successful and safe in terms of long-term symptomatic relief and acid reflux control in the surgical treatment of achalasia.

Keywords

Achalasia Laparoscopic heller-myotomy with Dor-fundoplication Long-term results Esophagitis.

References

  • 1. Schlottmann F, Neto RML, Herbella FAM, Patti MG. Esophageal achalasia: Pathophysiology, clinical presentation, and diagnostic evaluation. Am Surg. 2018;4:84:467–4.
  • 2. Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol. 2018;12:711-21. doi: 10.1080/17474124.2018.1481748.
  • 3. Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018;31. doi: 10.1093/dote/doy071.
  • 4. Inaba CS, Wright AS. Laparoscopic Heller myotomy and Toupet fundoplication for achalasia. J Laparoendosc Adv Surg Tech. 2020;30: doi:10.1089/lap.2020.0158
  • 5. Schlottmann F, Nurczyk K, Patti MG. Laparoscopic Heller Myotomy and Dor Fundoplication: How I Do It? J Laparoendosc Adv Surg Tech A. 2020 Jun;30(6):627-9. doi:10.1089/lap.2020.0157.
  • 6. Rawlings A, Soper NJ, Oelschlager BK. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: Results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26:18–26. doi: 10.1007/s00464-011-1822-y. Epub 2011 Jul 26.
  • 7. Kumagai K, Kjellin A, Tsai JA, Thorell A, Granqvist S, Lundell L, et al. Toupet versus Dor as a procedure to prevent reflux after cardiomyotomy for achalasia: Results of a randomised clinical trial. Int J Surg. 2014;12:673–80. doi: 10.1016/j.ijsu.2014.05.077. Epub 2014 Jun 2.
  • 8. Torres-Billalobos G, Coss-Adame E, Furuzawa-Carballeda J, Romero-Hernandez F, Blancas-Brena B, Torres-Landa S, et al. Dor vs Toupet fundoplication after laparoscopic Heller myotomy: Long-term randomized controlled trial evaluated by high-resolution manometry. J Gastrointest Surg. 2018;22:13–22. doi: 10.1007/s11605-017-3578-8. Epub 2017 Sep 18.
  • 9. Japan Eshophageal Society. Descriptive rules for achalasia of the esophagus, June 2012: 4th edition. Esophagus. 2017;14:275–89. doi: 10.1007/s10388-017-0589-1
  • 10. Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103:1732–8. doi: 10.1016/0016-5085(92)91428-7.
  • 11. Lundell L, Dent J, Bennett J, Blum A, Armstrong D, Galmiche J, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80. doi: 10.1136/gut.45.2.172.
  • 12. Heller E. Extramukose cardioplastik beim chronischen kardiospasmus mit dilatation des oesophagus. Mitt Grenzgeb Med Chir. 1914;27:141–9.
  • 13. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb. 1991;36(3):152–4.
  • 14. Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg. 1999;230(4):587–93. doi: 10.1097/00000658-199910000-00014.
  • 15. Zaninotto G, Costantini M, Rizzetto C, zanatta L, Guirroli E, Portale G, et al. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248(6):986–93. doi: 10.1097/SLA.0b013e3181907bdd.
  • 16. Schlottmann F, Andolfi C, Kavitt RT, Konda VJA, Patti MG. Multidisciplinary approach to esophageal achalasia: a single center experience. J Laparoendosc Adv Surg Tech A. 2017;27(4):358–62. doi: 10.1089/lap.2016.0594
  • 17. Costantini M, Salvador R, Capovilla G, Vallese L, Costantini A, Nicoletti L, et al. A thousand and one laparoscopic heller myotomies for esophageal achalasia: a 25-year experience at a single tertiary center. J Gastrointest Surg. 2019;23:23–35. doi: 10.1007/s11605-018-3956-x
  • 18. Fukushima N, Masuda T, Yano F, Omura N, Tsuboi K, Hoshino M, et al. Over ten year outcomes of laparoscopic Heller myotomy with Dor fundoplication with achalasia: single center experience with annual endoscopic surveillance. Surg Endosc. 2020;Nov 13. doi: 10.1007/s00464-020-08148-5. Online ahead of print.
  • 19. Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol. 2008;103(1):27–37. doi: 10.1111/j.1572-0241.2007.01532.x
  • 20. Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015;3(3):E195–201. doi: 10.1055/s-0034-1391668
  • 21. Aiolfi A, Tornese S, Bonitta G, Cavalli M, Rausa E, Micheletto G, et al. Dor versus Toupet fundoplication after laparoscopic Heller myotomy: Systematic review and Bayesian meta-analysis of randomized controlled trials. Asian J Surg. 2020;43:20–8. doi: 10.1016/j.asjsur.2019.03.019
  • 22. Siddaiah-Subramanya M, Yunus RM, Khan S, Memon B, Memon MA. Anterior Dor or posterior Toupet with Heller myotomy for achalasia cardia: A systematic review and meta-analysis. World J Surg. 2019;43:1563–70. doi: 10.1007/s00268-019-04945-9
  • 23. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttutta A, et al. Pneumatic Dilation versus Laparoscopic Heller’s Myotomy for Idiopathic Achalasia. N Engl J Med. 2011;364:1807–16. doi: 10.1056/NEJMoa1010502
  • 24. Campos G, Vittinghof E, Rabl C, Takata M, Gadenstätter M, Lin F, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249:45–57. doi: 10.1097/SLA.0b013e31818e43ab
  • 25. Costantini A, Familiari P, Costantini M, Salvador R, Valmasoni M, Capovilla G, et al. Poem versus laparoscopic heller myotomy in the treatment of esophageal achalasia: a case control study from two high volume centers using the propensity score. J Gastrointest Surg. 2020;24:505–15. doi: 10.1007/s11605-019-04465-w.

Year 2021, Volume: 5 Issue: 9, 937 - 940, 01.09.2021

Ali Sürmelioğlu Doğukan Akkuş

https://doi.org/10.28982/josam.981343

Abstract

References

  • 1. Schlottmann F, Neto RML, Herbella FAM, Patti MG. Esophageal achalasia: Pathophysiology, clinical presentation, and diagnostic evaluation. Am Surg. 2018;4:84:467–4.
  • 2. Schlottmann F, Patti MG. Esophageal achalasia: current diagnosis and treatment. Expert Rev Gastroenterol Hepatol. 2018;12:711-21. doi: 10.1080/17474124.2018.1481748.
  • 3. Zaninotto G, Bennett C, Boeckxstaens G, Costantini M, Ferguson MK, Pandolfino JE, et al. The 2018 ISDE achalasia guidelines. Dis Esophagus. 2018;31. doi: 10.1093/dote/doy071.
  • 4. Inaba CS, Wright AS. Laparoscopic Heller myotomy and Toupet fundoplication for achalasia. J Laparoendosc Adv Surg Tech. 2020;30: doi:10.1089/lap.2020.0158
  • 5. Schlottmann F, Nurczyk K, Patti MG. Laparoscopic Heller Myotomy and Dor Fundoplication: How I Do It? J Laparoendosc Adv Surg Tech A. 2020 Jun;30(6):627-9. doi:10.1089/lap.2020.0157.
  • 6. Rawlings A, Soper NJ, Oelschlager BK. Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: Results of a multicenter, prospective, randomized-controlled trial. Surg Endosc. 2012;26:18–26. doi: 10.1007/s00464-011-1822-y. Epub 2011 Jul 26.
  • 7. Kumagai K, Kjellin A, Tsai JA, Thorell A, Granqvist S, Lundell L, et al. Toupet versus Dor as a procedure to prevent reflux after cardiomyotomy for achalasia: Results of a randomised clinical trial. Int J Surg. 2014;12:673–80. doi: 10.1016/j.ijsu.2014.05.077. Epub 2014 Jun 2.
  • 8. Torres-Billalobos G, Coss-Adame E, Furuzawa-Carballeda J, Romero-Hernandez F, Blancas-Brena B, Torres-Landa S, et al. Dor vs Toupet fundoplication after laparoscopic Heller myotomy: Long-term randomized controlled trial evaluated by high-resolution manometry. J Gastrointest Surg. 2018;22:13–22. doi: 10.1007/s11605-017-3578-8. Epub 2017 Sep 18.
  • 9. Japan Eshophageal Society. Descriptive rules for achalasia of the esophagus, June 2012: 4th edition. Esophagus. 2017;14:275–89. doi: 10.1007/s10388-017-0589-1
  • 10. Eckardt VF, Aignherr C, Bernhard G. Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992;103:1732–8. doi: 10.1016/0016-5085(92)91428-7.
  • 11. Lundell L, Dent J, Bennett J, Blum A, Armstrong D, Galmiche J, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–80. doi: 10.1136/gut.45.2.172.
  • 12. Heller E. Extramukose cardioplastik beim chronischen kardiospasmus mit dilatation des oesophagus. Mitt Grenzgeb Med Chir. 1914;27:141–9.
  • 13. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb. 1991;36(3):152–4.
  • 14. Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg. 1999;230(4):587–93. doi: 10.1097/00000658-199910000-00014.
  • 15. Zaninotto G, Costantini M, Rizzetto C, zanatta L, Guirroli E, Portale G, et al. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248(6):986–93. doi: 10.1097/SLA.0b013e3181907bdd.
  • 16. Schlottmann F, Andolfi C, Kavitt RT, Konda VJA, Patti MG. Multidisciplinary approach to esophageal achalasia: a single center experience. J Laparoendosc Adv Surg Tech A. 2017;27(4):358–62. doi: 10.1089/lap.2016.0594
  • 17. Costantini M, Salvador R, Capovilla G, Vallese L, Costantini A, Nicoletti L, et al. A thousand and one laparoscopic heller myotomies for esophageal achalasia: a 25-year experience at a single tertiary center. J Gastrointest Surg. 2019;23:23–35. doi: 10.1007/s11605-018-3956-x
  • 18. Fukushima N, Masuda T, Yano F, Omura N, Tsuboi K, Hoshino M, et al. Over ten year outcomes of laparoscopic Heller myotomy with Dor fundoplication with achalasia: single center experience with annual endoscopic surveillance. Surg Endosc. 2020;Nov 13. doi: 10.1007/s00464-020-08148-5. Online ahead of print.
  • 19. Pandolfino JE, Ghosh SK, Rice J, Clarke JO, Kwiatek MA, Kahrilas PJ. Classifying esophageal motility by pressure topography characteristics: a study of 400 patients and 75 controls. Am J Gastroenterol. 2008;103(1):27–37. doi: 10.1111/j.1572-0241.2007.01532.x
  • 20. Kumbhari V, Tieu AH, Onimaru M, El Zein MH, Teitelbaum EN, Ujiki MB, et al. Peroral endoscopic myotomy (POEM) vs laparoscopic Heller myotomy (LHM) for the treatment of type III achalasia in 75 patients: a multicenter comparative study. Endosc Int Open. 2015;3(3):E195–201. doi: 10.1055/s-0034-1391668
  • 21. Aiolfi A, Tornese S, Bonitta G, Cavalli M, Rausa E, Micheletto G, et al. Dor versus Toupet fundoplication after laparoscopic Heller myotomy: Systematic review and Bayesian meta-analysis of randomized controlled trials. Asian J Surg. 2020;43:20–8. doi: 10.1016/j.asjsur.2019.03.019
  • 22. Siddaiah-Subramanya M, Yunus RM, Khan S, Memon B, Memon MA. Anterior Dor or posterior Toupet with Heller myotomy for achalasia cardia: A systematic review and meta-analysis. World J Surg. 2019;43:1563–70. doi: 10.1007/s00268-019-04945-9
  • 23. Boeckxstaens GE, Annese V, des Varannes SB, Chaussade S, Costantini M, Cuttutta A, et al. Pneumatic Dilation versus Laparoscopic Heller’s Myotomy for Idiopathic Achalasia. N Engl J Med. 2011;364:1807–16. doi: 10.1056/NEJMoa1010502
  • 24. Campos G, Vittinghof E, Rabl C, Takata M, Gadenstätter M, Lin F, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249:45–57. doi: 10.1097/SLA.0b013e31818e43ab
  • 25. Costantini A, Familiari P, Costantini M, Salvador R, Valmasoni M, Capovilla G, et al. Poem versus laparoscopic heller myotomy in the treatment of esophageal achalasia: a case control study from two high volume centers using the propensity score. J Gastrointest Surg. 2020;24:505–15. doi: 10.1007/s11605-019-04465-w.
There are 25 citations in total.

Details

Primary Language English
Subjects Surgery
Journal Section Research article
Authors

Ali Sürmelioğlu 0000-0002-7697-0930

Doğukan Akkuş 0000-0003-2259-6944

Publication Date September 1, 2021
Published in Issue Year 2021 Volume: 5 Issue: 9

Cite

APA Sürmelioğlu, A., & Akkuş, D. (2021). Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience. Journal of Surgery and Medicine, 5(9), 937-940. https://doi.org/10.28982/josam.981343
AMA Sürmelioğlu A, Akkuş D. Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience. J Surg Med. September 2021;5(9):937-940. doi:10.28982/josam.981343
Chicago Sürmelioğlu, Ali, and Doğukan Akkuş. “Long-Term Results of Laparoscopic Heller Myotomy With Dor-Fundoplication in Surgical Treatment of Achalasia: A Single-Center Experience”. Journal of Surgery and Medicine 5, no. 9 (September 2021): 937-40. https://doi.org/10.28982/josam.981343.
EndNote Sürmelioğlu A, Akkuş D (September 1, 2021) Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience. Journal of Surgery and Medicine 5 9 937–940.
IEEE A. Sürmelioğlu and D. Akkuş, “Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience”, J Surg Med, vol. 5, no. 9, pp. 937–940, 2021, doi: 10.28982/josam.981343.
ISNAD Sürmelioğlu, Ali - Akkuş, Doğukan. “Long-Term Results of Laparoscopic Heller Myotomy With Dor-Fundoplication in Surgical Treatment of Achalasia: A Single-Center Experience”. Journal of Surgery and Medicine 5/9 (September 2021), 937-940. https://doi.org/10.28982/josam.981343.
JAMA Sürmelioğlu A, Akkuş D. Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience. J Surg Med. 2021;5:937–940.
MLA Sürmelioğlu, Ali and Doğukan Akkuş. “Long-Term Results of Laparoscopic Heller Myotomy With Dor-Fundoplication in Surgical Treatment of Achalasia: A Single-Center Experience”. Journal of Surgery and Medicine, vol. 5, no. 9, 2021, pp. 937-40, doi:10.28982/josam.981343.
Vancouver Sürmelioğlu A, Akkuş D. Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience. J Surg Med. 2021;5(9):937-40.
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