Features and results of minimally invasive treatment of recurrent achalasia

• Published in: Hirurgija (Moskva) no. 3; p. 16
• Main Authors: Gallyamov, E A, Erin, S A, Gololobov, G Yu, Burmistrov, A I, Chicherina, M A, Rikunova, A A
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 2022
• Subjects: Adult; COVID-19; Esophageal Achalasia - diagnosis; Esophageal Achalasia - surgery; Female; Humans; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Middle Aged; SARS-CoV-2; Treatment Outcome; methods of achalasia management; recurrent achalasia; modified laparoscopic Heller cardiomyotomy with Dor fundoplication
• ISSN: 0023-1207
• DOI: 10.17116/hirurgia202203116

To evaluate the early and long-term postoperative outcomes in patients with recurrent achalasia, as well as the main features of surgical treatment.
There were 7 patients (4 men and 3 women) with recurrent achalasia. Mean age of patients was 42.3±13.5 years, body mass index - 22.7±3.3 kg/m
. Physiological status ASA grade 1-3 was observed in all patients. Concomitant diseases were diagnosed in 5 (71.4%) cases. Six (85.7%) patients underwent laparoscopic Heller cardiomyotomy with Dor fundoplication. Peroral endoscopic myotomy (POEM) was performed in 1 (14.3%) patient. Mean preoperative Eckardt score was 10.7±1.4 points, mean GERD-HRQL score - 42.7±6.4 points. According to preoperative radiography, 5 (71.4%) patients had achalasia stage III, 2 (28.6%) ones - stage IV.
All patients underwent laparoscopic Heller esophagocardiomyotomy with anterior Dor fundoplication and posterior partial fundoplication with posterior cruroraphy. Intraoperative complications (perforation of esophageal mucosa) occurred in 3 (42.9%) patients. Mean surgery time was 130±56 min, mean blood loss - 37 ml (35-205 ml), mean hospital-stay - 11.3±7.7 days. Postoperative complications Clavien-Dindo grade 3-4 were detected in 1 (14.3%) patient. One patient was diagnosed with bilateral pneumonia (SARS-Cov-2 infection) in 4 postoperative days. Median postoperative follow-up period was 22 months. Mean BMI in 6 months after surgery was 25.3±3.1 kg/m
, mean Eckardt score - 2.1±0.7 points, mean GERD-HRQL score - 3.3±0.9 points.
Our data confirm the effectiveness and safety of the modified laparoscopic Heller procedure with Dor fundoplication as the main method for recurrent achalasia.