The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique
Background: Laparoscopic Heller myotomy (LHM) can be performed by blunt dissection technique (BDT). Only a few studies have assessed long-term outcomes and relief of dysphagia following LHM. The study reviews our long-term experience following LHM by BDT. Methods: This retrospective study was analys...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2023-01-01
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| Series: | Journal of Minimal Access Surgery |
| Subjects: | |
| Online Access: | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2023;volume=19;issue=3;spage=408;epage=413;aulast=Chauhan |
| _version_ | 1797738544616177664 |
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| author | Vivek Chauhan Phani Kumar Nekarakanti Deepak Balachandra Devendra Choudhary Sanjeev Sachdeva Hirdaya Hulas Nag |
| author_facet | Vivek Chauhan Phani Kumar Nekarakanti Deepak Balachandra Devendra Choudhary Sanjeev Sachdeva Hirdaya Hulas Nag |
| author_sort | Vivek Chauhan |
| collection | DOAJ |
| description | Background: Laparoscopic Heller myotomy (LHM) can be performed by blunt dissection technique (BDT). Only a few studies have assessed long-term outcomes and relief of dysphagia following LHM. The study reviews our long-term experience following LHM by BDT.
Methods: This retrospective study was analysed from a prospectively maintained database (from 2013 to 2021) of a single unit of the Department of Gastrointestinal Surgery at G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. The myotomy was performed by BDT in all patients. A fundoplication was added in selected patients. Post-operative Eckardt score >3 was considered treatment failure.
Results: A total of 100 patients underwent surgery during the study period. Of them, 66 patients underwent LHM, 27 underwent LHM with Dor fundoplication and 7 underwent LHM with Toupet fundoplication. The median length of myotomy was 7 cm. The mean operative time was 77 ± 29.27 min and the mean blood loss of 28.05 ± 16.06 ml. Five patients had intraoperative oesophageal perforation. The median length of hospital stay was 2 days. There was no hospital mortality. The post-operative integrated relaxation pressure (IRP) was significantly lower than the mean pre-operative IRP (9.78 vs. 24.77). Eleven patients developed treatment failure, of which ten patients presented with recurrence of dysphagia. There was no difference in symptom-free survival amongst various types of achalasia cardia (P = 0.816).
Conclusion: LHM performed by BDT has a 90% success rate. Complication using this technique is rare, and recurrence post-surgery can be managed with endoscopic dilatation. |
| first_indexed | 2024-03-12T13:45:18Z |
| format | Article |
| id | doaj.art-af9262e16ef340cf8f66890e84eedb02 |
| institution | Directory Open Access Journal |
| issn | 0972-9941 1998-3921 |
| language | English |
| last_indexed | 2024-03-12T13:45:18Z |
| publishDate | 2023-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Minimal Access Surgery |
| spelling | doaj.art-af9262e16ef340cf8f66890e84eedb022023-08-23T09:42:54ZengWolters Kluwer Medknow PublicationsJournal of Minimal Access Surgery0972-99411998-39212023-01-0119340841310.4103/jmas.jmas_273_22The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection techniqueVivek ChauhanPhani Kumar NekarakantiDeepak BalachandraDevendra ChoudharySanjeev SachdevaHirdaya Hulas NagBackground: Laparoscopic Heller myotomy (LHM) can be performed by blunt dissection technique (BDT). Only a few studies have assessed long-term outcomes and relief of dysphagia following LHM. The study reviews our long-term experience following LHM by BDT. Methods: This retrospective study was analysed from a prospectively maintained database (from 2013 to 2021) of a single unit of the Department of Gastrointestinal Surgery at G. B. Pant Institute of Postgraduate Medical Education and Research, New Delhi. The myotomy was performed by BDT in all patients. A fundoplication was added in selected patients. Post-operative Eckardt score >3 was considered treatment failure. Results: A total of 100 patients underwent surgery during the study period. Of them, 66 patients underwent LHM, 27 underwent LHM with Dor fundoplication and 7 underwent LHM with Toupet fundoplication. The median length of myotomy was 7 cm. The mean operative time was 77 ± 29.27 min and the mean blood loss of 28.05 ± 16.06 ml. Five patients had intraoperative oesophageal perforation. The median length of hospital stay was 2 days. There was no hospital mortality. The post-operative integrated relaxation pressure (IRP) was significantly lower than the mean pre-operative IRP (9.78 vs. 24.77). Eleven patients developed treatment failure, of which ten patients presented with recurrence of dysphagia. There was no difference in symptom-free survival amongst various types of achalasia cardia (P = 0.816). Conclusion: LHM performed by BDT has a 90% success rate. Complication using this technique is rare, and recurrence post-surgery can be managed with endoscopic dilatation.http://www.journalofmas.com/article.asp?issn=0972-9941;year=2023;volume=19;issue=3;spage=408;epage=413;aulast=Chauhanachalasia cardiablunt dissection techniquedysphagiafundoplicationheller myotomylaparoscopy |
| spellingShingle | Vivek Chauhan Phani Kumar Nekarakanti Deepak Balachandra Devendra Choudhary Sanjeev Sachdeva Hirdaya Hulas Nag The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique Journal of Minimal Access Surgery achalasia cardia blunt dissection technique dysphagia fundoplication heller myotomy laparoscopy |
| title | The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique |
| title_full | The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique |
| title_fullStr | The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique |
| title_full_unstemmed | The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique |
| title_short | The outcome of 100 patients with achalasia cardia following laparoscopic Heller myotomy with blunt dissection technique |
| title_sort | outcome of 100 patients with achalasia cardia following laparoscopic heller myotomy with blunt dissection technique |
| topic | achalasia cardia blunt dissection technique dysphagia fundoplication heller myotomy laparoscopy |
| url | http://www.journalofmas.com/article.asp?issn=0972-9941;year=2023;volume=19;issue=3;spage=408;epage=413;aulast=Chauhan |
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