Over ten-year outcomes of laparoscopic Heller-myotomy with Dor-fundoplication with achalasia: single-center experience w
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and Other Interventional Techniques
Over ten‑year outcomes of laparoscopic Heller‑myotomy with Dor‑fundoplication with achalasia: single‑center experience with annual endoscopic surveillance Naoko Fukushima1 · Takahiro Masuda1 · Fumiaki Yano1 · Nobuo Omura1 · Kazuto Tsuboi1 · Masato Hoshino1 · Se Ryung Yamamoto1 · Shunsuke Akimoto1 · Yuki Sakashita1 · Norio Mitsumori1 · Hideyuki Kashiwagi1 · Toru Ikegami1 Received: 3 July 2020 / Accepted: 3 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Laparoscopic Heller-myotomy with Dor-fundoplication (LHD) is the standard surgical treatment for achalasia; however, surgical outcomes over a period greater than 10 years have not been well-explored. The objective of this study was to evaluate the long-term outcomes of LHD for achalasia based on a single-center experience. Methods Patients who underwent LHD between 1994 and 2019 were included. Of these, we excluded patients who had undergone foregut surgery or whose follow-up data were unavailable. Esophagogastroduodenoscopy (EGD) findings and postoperative persistent and/or recurrent symptoms had been assessed annually. Disease-free rates were calculated using Kaplan–Meier analysis. Results A total of 530 patients (mean age 45.0 years with 267 men) were included. The median follow-up period was 50.5 months. More than 10 years’ data were available in 78 patients (14.7%). The cumulative rates of freedom from dysphagia, vomiting, chest pain, and Eckardt score > 3 at 10 years after LHD were 80.1%, 97.5%, 96.3%, and 73.5%, respectively. Probability of esophagitis during 10 years after surgery was 34.4% of patients based on Kaplan–Meier estimation. Approximately 3/4th of patients who had post-LHD esophagitis showed mild esophagitis of Los Angeles classification grade A. Fifteen patients (2.8%) were required a revision of primary LHD. Six patients (1.2%) developed esophageal cancer with an incidence was as high as 219.8/100,000 person-year. All patients with esophageal cancer were found to have early stage tumors that were successfully resected. Conclusions Symptomatic relief post-LHD lasted for over 10 years. The incidence rate of esophageal cancer was high. Regular EGD surveillance seems to be helpful for early detection of esophageal cancer early. Keywords Achalasia · Laparoscopic heller-myotomy with Dor-fundoplication · Long-term outcomes · Myotomy · Esophagitis · Endoscopy Abbreviations aSg Advanced sigmoid BMI Body mass index EGD Esophagogastroduodenoscopy Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00464-020-08148-5) contains supplementary material, which is available to authorized users. * Naoko Fukushima [email protected] 1
Department of Surgery, The Jikei University School of Medicine, 3‑25‑8, Nishishinbashi, Minato‑ku, Tokyo 105‑8461, Japan
HRM High-resolution manometry JES Japan Esophageal Society classification LES Lower esophageal sphincter LHD Laparoscopic Heller-myotomy with Dor-fundoplication
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