Laparoscopic heller myotomy is equally efficient and safe in patients who had pre-myotomy endoscopic interventions when compared with those with no interventions

• DOI: 10.26663/cts.2017.0001
• Publication Date: 2017-08-25T18:16:05Z
• Authors: Zeynep Bilgi; Adamu Issaka; Hasan Fevzi Batırel
• Keywords: Achalasia;Heller myotomy;botulinum toxin;surgery; 3. Good health

Background:Endoscopic treatment (ET) methods for achalasia suchas balloon dilatation and botulinum toxin injection has good success for shortand medium term management of achalasia. However some patients either needrepeat attempts or referred to surgery. In this study we analyzed and compared theperioperative and disease specific quality of life outcomes of achalasiapatients who either underwent surgery as a first line treatment and the oneswho underwent ET method prior to surgery.Materials and Methods: The patients who underwent standard ofcare diagnostic workup and surgery for achalasia by the same surgical teambetween 2007 and 2014 were recorded in a prospective database. The patients whounderwent surgery as a first line treatment (Group 1, n=55) and the patientswho underwent prior ET (Group 2, n=33) were identified. Demographic data,peroperative complications, length of hospital stay, pre- and postoperativeEckardt scores were recorded and analyzed. Results:A total of 88 patients out of 105 were available forfollow up with average follow up time of 61.9 ± 35.8 months. The mean age was43.3 ± 15.6. Mean hospital stay was 2.3 ± 0.8 days and there was no mortality.Average duration of the effectivity of ET before myotomy was 5.7 ± 7.7 months.Peroperative complications not significantly accumulated in either group. Bothgroups showed comparable drop in Eckardt scores. Conclusions: Hellermyotomy and Dor fundoplication is a safe and durable option for treatment ofachalasia for both treatment naive patients and patients with previous repeatedET modalities.