EARLY OUTCOME OF LAPAROSCOPIC HELLER'S CADIOMYOTOMY - SINGLE UNIT EXPERIENCE
Vibhuthi Arampola, Chathuranga T. Keppetiyagama*, Udaya Kalubowila, Gihan Padmakeerthi
Surgery, National Hospital Kandy, Kandy, Central, Sri Lanka
Background
Achalasia cardia is a benign oesophageal condition that results in significant dysphagia. The gold standard treatment is laparoscopic heller's cardiomyotomy with a fundal wrap preferably dor or toupet fundoplication. Other treatment modalities include per-oral endoscopic myotomy (POEM), balloon dilatation, and endoscopic Botox injections.
Methodology
Retrospective data analysis of 12 patients who underwent Laparoscopic heller's cardio-myotomy were evaluated, among which all 3 types of achalasia were included. Patients underwent laparoscopic heller's myotomy with and without anti-reflux procedures such as dor and toupet fundoplication. All patients confirmed the diagnosis and the type of achalasia with high-resolution manometry. They were assessed in the clinic in the 1st, 3rd month, and first year postoperatively in terms of postoperative dysphagia, reflux, and recurrence of symptoms.
Results
In the sample of 12 patients who underwent heller's myotomy, 8(66.6.%) are females and 4 (33.3%) were males. The mean age was 48.6 years. The mean Eckardt score is 5. 71.4% had Type 2 Achalasia and, 14.3% had Type 1 and 3 Achalasia for each. Three patients have undergone previous achalasia dilation at least once. None of the surgeries had intraoperative complications such as significant operative blood loss, perforation, other organ damage, conversion, or immediate post-operative complications. But Dysphagia recurred after 3 months in 10% and after 1 year in 20%of patients, one required a POEM. 2.60% of patients had post-op reflux. Two out of 4 patients (50%) who underwent the anti-reflux procedure and 4 out of 7 (57.14%) patients who had no anti-reflux procedure, recurred with reflux within one year.
Conclusion
Laparoscopic heller's cardio-myotomy gives the best early outcomes with minimal complications. Further evaluation for improved sensitivity, a bigger sample size is recommended.
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