Balancing relief and reflux: A prospective comparative study on gastric myotomy length and post-operative outcomes in laparoscopic Heller's myotomy for achalasia.

INTRODUCTION

Laparoscopic Heller's myotomy (LHM) with a partial fundoplication is the standard surgical therapy for achalasia cardia. However, the ideal gastric extension of the myotomy remains controversial, as it may influence both symptom relief and post-operative gastro-oesophageal reflux disease (GORD). This study prospectively assessed the impact of gastric myotomy length on clinical outcomes after LHM with Dor fundoplication.

PATIENTS AND

METHODS

In this prospective non-randomised comparative interventional study, patients undergoing LHM with Dor fundoplication were divided into three groups according to gastric myotomy length: Group A (<1.5 cm), Group B (1.5-2.5 cm) and Group C (>2.5 cm). The primary outcome was improvement in the Eckardt score at 1, 3 and 6 months postoperatively. The secondary outcomes included GORD incidence (Gastro-Oesophageal Reflux Disease Questionnaire [GORD-Q]), complications and re-intervention rates.

RESULTS

Sixty-three patients were included ( n = 21 per group). All groups showed significant symptom improvement post-surgery. At 3 and 6 months, Groups B and C demonstrated greater Eckardt score improvement than Group A ( P = 0.012 and P < 0.01, respectively). Median GORD-Q scores were similar at 1 and 3 months but higher in Group C at 6 months ( P = 0.01). Re-intervention was most frequent in Group A (23.8%) due to persistent dysphagia ( P = 0.047). Operative time, hospital stay and complications did not differ significantly among the groups.

CONCLUSION

Gastric myotomy beyond 1.5 cm improves symptom control after LHM with Dor fundoplication, but extension beyond 2.5 cm increases reflux risk. A length of 1.5-2.5 cm appears optimal for balancing dysphagia relief and reflux prevention.