Follow Up After Heller Cardiomyotomy for Achalasia, Combined Prospective and Retrospective Study

Abstract

Background: Achalasia is an idiopathic esophageal motility disorder characterized by non-relaxation of the lower esophageal sphincter. The purpose of achalasia treatment is symptom improvement, which is achieved by reducing LES resting pressure thus enabling the food bolus passage into the stomach.Combination of Heller myotomy with Dor fundoplication is recommended to decrease postoperative pathologic gastroesophageal reflux.Aim: To evaluate the post-operative outcomes after Heller cardiomyotomy and Dor fundoplication for patients diagnosed with achalasia.Methods: This combined prospective and retrospective study included 362 patients who underwent the Heller procedure for achalasia. Patients were asked to score their symptom severity based on the Eckardt scoring (ES) system, which was comprised of four symptoms: dysphagia, regurgitation, retrosternal pain, and weight loss. All cases were followed for at least one year after operation.Results: The procedure was associated with a significant decline in Eckardt dysphagia, Eckardt chest pain, Eckardt regurgitation and weight loss scores over the two-year follow-up period. EAT-10 score expressed significantly decline over the two-year follow-up period. The total Eckardt score showed a significant decline after the procedure compared to the baseline value. GERDHRQL increased significantly after the myotomy procedure, as it had increased follow-up values compared to the corresponding baseline ones. Conclusion: The Heller-Dor operation provides sustained symptom relief and a satisfactory quality of life two years after surgery.