Endoskopie, 2011; 20(3-4): 112-117

Long-term outcomes of laparoscopic myotomy for achalasia with a range of antireflux procedures

MUDr.Václav Drahoňovský, MUDr.Luděk Winkler, MUDr.Patrik Pecák

Palas Athéna s. r. o., Klinika jednodenní chirurgie, Praha

Objective: From 1995 to 2007, we performed 101 laparoscopic surgeries for stage I to stage IV achalasias with three types of antireflux

procedures: anterior Dor, posterior Toupet and circular Nissen-Rossetti (NR); in stage IV, myotomy alone was performed. Various antireflux

procedures were carried out depending on the stage of achalasia, presence of hiatal hernia, shape and location of the hiatus and

size of the gastric fundus. The study aims at determining the long-term outcomes including subsequent gastroesophageal reflux after

laparoscopic surgery.

Method: All the patients operated were sent GIQLI (Gastrointestinal Quality of Life Index) questionnaires; Likert reflux score before and

after the surgery performed; and score of satisfaction with the surgery performed (excellent, good, satisfactory and poor). All the data

required were obtained from 81 patients operated.

Results: Myotomy + circular Nissen-Rossetti procedure group: 31 patients with a median follow-up of 6.5 years. Likert reflux score before

and after surgery: 110/25 points, GIQLI: 126.2 points (healthy population has a score of 120 points), score of satisfaction: excellent 22 and

good 6, a total of 28 of the 31 followed. Myotomy + posterior partial Toupet procedure group: 33 patients with a median follow-up of 5.8

years. Likert reflux score before and after surgery: 132/77 points, GIQLI: 122 points, score of satisfaction: excellent 14, good 17, a total of 31

of the 33 followed. Myotomy + anterior Dor procedure group: 10 patients with a median follow-up of 11.1 years. Likert reflux score before

and after surgery: 22/13 points, GIQLI: 120.6 points, score of satisfaction: excellent 5 and good 5, a total of 10 of the 10 followed.

Myotomy without antireflux procedure group: 7 patients with a median follow-up of 9.4 years. Likert reflux score before and after surgery:

29/19 points, GIQLI: 106.3 points, score of satisfaction: excellent 3, good 2, a total of 5 of the 7 followed.

Conclusion: Laparoscopic myotomy with antireflux procedure for achalasia is a safe method with a very good symptomatic effect lasting

on average for more than eight years after the surgery performed. The best lasting antireflux effect was shown in circular and posterior

partial antireflux procedures. When performed well, antireflux procedures do not worsen dysphagia.

Keywords: achalasia, laparoscopic Heller myotomy, antireflux procedure, quality of life

Published: December 28, 2011  Show citation