Background/objectives: Laparoscopic Heller myotomy with Dor fundoplication has been utilized at Duke University Medical Center as a form of treatment for achalasia since 1994. To date, a total of 66 patients have undergone this procedure. Since this procedure has only been reported in a few small series, our data, including mid-term follow-up, is reviewed to evaluate the efficacy of this procedure.
Methods: Hospital charts and operative records were reviewed, and telephone interviews performed with patients having undergone laparoscopic Heller myotomy with Dor Fundoplication. All procedures included intraoperative gastroscopy. Patients were evaluated for prior treatment, operative complications, hospital stay, post-operative satisfaction with procedure (using a Likert satisfaction survey), return of dysphagia, and need for subsequent treatment.
Results: Median follow-up was 35 months. 56% of patients undergoing surgery had undergone prior esophageal dilation. 15 % had undergone botulinum toxin injection. All operations were completed successfully. Complications included a single esophageal perforation which was repaired laparoscopically. There was one conversion to open procedure. There were no deaths. Average hospital stay was 1.8 days. Average Likert satisfaction survey score (scale 1-5) was 4.61. 17% of patients report occasional dysphagia to some solids, none to liquids. 6.5% of patients report having undergone repeat balloon dilation since their surgery.
Conclusion: Laparoscopic Heller myotomy with Dor Fundoplication and intraoperative gastroscopy is a safe and effective treatment for achalasia. Our series demonstrates minimal morbidity when performed by an experienced laparoscopic surgeon and overall excellent mid-term results. This procedure should be considered as an early treatment option for symptomatic achalasia patients.
