Frontiers in surgery · 2026
Laparoscopic Heller myotomy with Dor fundoplication for achalasia: an outcome in a tertiary health center of Nepal.
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Deo Kunal Bikram, Regmi Parbatraj, Pandit Narendra, Yogi Barurendra Raj, Sah Bed Prakash, Budhathoki Ulav, Adhikary Shailesh
Аннотация
INTRODUCTION: Laparoscopic Heller Myotomy with Dor fundoplication is the most effective therapeutic option for Achalasia cardia, with fewer complications. We present the outcomes of this procedure with long-term follow-up in patients with Achalasia cardia.
METHODS: A single institution prospectively maintained data of Laparoscopic Heller Myotomy with Dor fundoplication between January 2014 and January 2024 was reviewed. Eckardt scores at three-time points (preoperative, 3-month, and long-term follow-up) were used to assess treatment efficacy.
RESULTS: A total of 16 patients had a median age of 34 years. Megaesophagus was observed in 8 (50%) patients, and 5 patients had sigmoid esophagus. The mean operative time was 162 ± 41 min. The mean myotomy length was 6.1 cm and 2.19 cm, respectively, for the esophagus and the stomach. Following the surgery, there was significant improvement in the Eckardt score from a median preoperative score of 9 (5-12) to a median postoperative score of 2(0-4) in 3 months (p = 0.001) and a median Eckardt score of 1.5 (0-3) in long-term follow-up (P < 0.001). The median long-term follow-up was 32 months (12-60 months). Overall, two treatment failure was observed, and one required endoscopic balloon dilatation. The gastroesophageal reflux (uncomplicated) was observed in 5 (31.2%) patients. The symptoms were mild, and none had reflux-related complications at the last follow-up.
CONCLUSIONS: LHM provides immediate and durable symptomatic relief with fewer complications.
METHODS: A single institution prospectively maintained data of Laparoscopic Heller Myotomy with Dor fundoplication between January 2014 and January 2024 was reviewed. Eckardt scores at three-time points (preoperative, 3-month, and long-term follow-up) were used to assess treatment efficacy.
RESULTS: A total of 16 patients had a median age of 34 years. Megaesophagus was observed in 8 (50%) patients, and 5 patients had sigmoid esophagus. The mean operative time was 162 ± 41 min. The mean myotomy length was 6.1 cm and 2.19 cm, respectively, for the esophagus and the stomach. Following the surgery, there was significant improvement in the Eckardt score from a median preoperative score of 9 (5-12) to a median postoperative score of 2(0-4) in 3 months (p = 0.001) and a median Eckardt score of 1.5 (0-3) in long-term follow-up (P < 0.001). The median long-term follow-up was 32 months (12-60 months). Overall, two treatment failure was observed, and one required endoscopic balloon dilatation. The gastroesophageal reflux (uncomplicated) was observed in 5 (31.2%) patients. The symptoms were mild, and none had reflux-related complications at the last follow-up.
CONCLUSIONS: LHM provides immediate and durable symptomatic relief with fewer complications.