Surgical endoscopy · 2025
Mid-term outcomes of the patients of achalasia cardia undergoing laparoscopic Heller's myotomy with angle of his accentuation versus laparoscopic Heller's myotomy with Toupet's fundoplication.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mittal Sonali, Kumar Aditya, Bale Manjunath, Singla Vitish, Makharia Govind, Gunjan Deepak, Parshad Rajinder
Аннотация
BACKGROUND: The choice of anti-reflux procedure with Laparoscopic Heller's myotomy (LHM) is debatable. LHM with Dor's fundoplication is the most common procedure performed and has shown similar outcomes to LHM with Toupet's fundoplication and LHM with Angle of His accentuation (AOH). The present study describes the mid-term outcomes comparing LHM with AOH and LHM with Toupet's fundoplication.
METHODS: Eighty-six patients who underwent LHM-AOH (group A, n = 43), versus LHM-Toupet's fundoplication (group B, n = 43) for achalasia cardia were followed up for symptomatic improvement (Eckardt score, ES ≤ 3), improvement in Achalasia disease specific health related quality of life (ADsQoL) and clinical reflux (DeMeester's heartburn score ≥ 2, and esophagitis on endoscopy).
RESULTS: At a median duration of 52.5 (IQR 34-67) months, mean ES in both groups decreased (7.42 to 1.2, p < 0.00001, group A and 7.37 to 1.23, p < 0.00001, group B) with no difference among the two groups. Mean ADsQoL scores decreased in both groups significantly (23.3 to 13.7, p < 0.00001, group A and 23.2 to 13.3, p < 0.00001, group B) with the mean ADsQoL scores at the last follow-up being statistically similar in both the groups (p = 0.93). Clinically significant heartburn was seen in 5 (11.6%) and 7 (16.3%) patients in group A and B, respectively (p = 0.76). Ninety-one and 95% patients in group A and B, respectively, had good to excellent satisfaction. Follow-up UGIE (median: 12 months) could be performed in 33 (group A) and 28 patients (group B), with 9 (27%) patients in group A and 4 (14.3%) patients in group B showing LA-A or B esophagitis (p = 0.22). No patient had LA-C/D esophagitis. Frequent use of proton pump inhibitors was there by 5 patients in each group (11.6%).
CONCLUSION: LHM-AOH and LHM-Toupet's fundoplication are comparable with respect to symptomatic relief, improvement in quality of life and clinical reflux rates.
METHODS: Eighty-six patients who underwent LHM-AOH (group A, n = 43), versus LHM-Toupet's fundoplication (group B, n = 43) for achalasia cardia were followed up for symptomatic improvement (Eckardt score, ES ≤ 3), improvement in Achalasia disease specific health related quality of life (ADsQoL) and clinical reflux (DeMeester's heartburn score ≥ 2, and esophagitis on endoscopy).
RESULTS: At a median duration of 52.5 (IQR 34-67) months, mean ES in both groups decreased (7.42 to 1.2, p < 0.00001, group A and 7.37 to 1.23, p < 0.00001, group B) with no difference among the two groups. Mean ADsQoL scores decreased in both groups significantly (23.3 to 13.7, p < 0.00001, group A and 23.2 to 13.3, p < 0.00001, group B) with the mean ADsQoL scores at the last follow-up being statistically similar in both the groups (p = 0.93). Clinically significant heartburn was seen in 5 (11.6%) and 7 (16.3%) patients in group A and B, respectively (p = 0.76). Ninety-one and 95% patients in group A and B, respectively, had good to excellent satisfaction. Follow-up UGIE (median: 12 months) could be performed in 33 (group A) and 28 patients (group B), with 9 (27%) patients in group A and 4 (14.3%) patients in group B showing LA-A or B esophagitis (p = 0.22). No patient had LA-C/D esophagitis. Frequent use of proton pump inhibitors was there by 5 patients in each group (11.6%).
CONCLUSION: LHM-AOH and LHM-Toupet's fundoplication are comparable with respect to symptomatic relief, improvement in quality of life and clinical reflux rates.