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Outcome After Surgical Treatment for Achalasia: Comparison of Sub-Classification Using High-Resolution Manometry
Se Ryung Yamamoto*
The Jikei University School of Medicine, Tokyo, Japan
Aim: Achalasia is classified into three subtypes using high-resolution manometry (HRM). The aim of this study was to compare the outcome after laparoscopic Heller-Dor procedure (LHD) in patients with such achalasia subtypes.
Methos: A retrospective study of a prospectively maintained database was conducted to identify patients who had underwent LHD after pre-operative HRM for achalasia between October 2010 and August 2012. Patients who had previous foregut surgeries were excluded. Pre- and post-operative symptoms were evaluated using a standard questionnaire with symptoms graded on a scale of 0-4. Post-operative patient’s satisfaction was also evaluated using a scale of 1-5.
Results: Fifty-Three patients met the criteria (mean age of 45.8 ± 18.2 years, 27 females). The subtype consisted of type I in 16 patients (30%), type II in 33 (62%) and type III in 4 (8%), and mean duration of symptoms was 88.3 ± 88.6 months. Of the 53 patients, all but one patient (98%) had dysphagia and 30 (57%) had chest pain. No significant differences in symptoms were identified between type I and II patients (p=0.897). Fifty-one patients (96%) had timed barium esophagogram (TBE) before surgery. By TBE, the morphologic type of achalasia was straight type in 43 (84%), sigmoid type in 7 (14%) and advanced sigmoid type in 1 patient (1%), and the severity of dilatation consisted of grade I in 17 (33%), grade II in 27 (53%), and grade III in 7 patients (14%). No significant differences in morphologic types and severity of dilatation on TBE were present between type I and type II achalasia (p=0.371 and 0.690, respectively). At a median follow-up of 7 (1-102) months, dysphagia was relieved in 51 patients (96%) and median post-operative satisfaction of 5 was achieved. No significant differences were identified in post-operative symptoms, satisfaction and TBE findings (p=0.521, 0.198 and 0.836, respectively). All patients with type III achalasia had improved symptoms after LHD and reported good satisfaction.
Conclusion: Heller-Dor procedure for achalasia results in excellent outcome. No significant difference was noted in short term outcome of Heller-Dor procedure between type I and II achalasia, and both patients reported good satisfaction as well as type III.
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