Achalasia and obesity: patient outcomes and impressions following laparoscopic Heller myotomy and Dor fundoplication
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ORIGINAL ARTICLE
Achalasia and obesity: patient outcomes and impressions following laparoscopic Heller myotomy and Dor fundoplication Jon M. Harrison 1,2 & Stephanie L. Rakestraw 1 & Stephen M. Doane 1 & Michael J. Pucci 1 & Francesco Palazzo 1 & Karen A. Chojnacki 1 Received: 20 November 2019 / Accepted: 16 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose The optimal management of achalasia in obese patients is unclear. For those who have undergone Heller myotomy and fundoplication, the long-term outcomes and their impressions following surgery are largely unknown. Methods A retrospective review of patients who underwent laparoscopic Heller myotomy and Dor fundoplication (LHMDF) for achalasia was performed. From this cohort, Class 2 and 3 obese (BMI > 35 kg/m2) patients were identified for short- and longterm outcome analysis. Results Between 2003 and 2015, 252 patients underwent LHMDF for achalasia, and 17 (7%) patients had BMI > 35 kg/m2. Preoperative Eckardt scores varied from 2 to 9, and at short-term (2–4 week) follow-up, scores were 0 or 1. Ten (58%) patients had available long-term (2–144 months) follow-up data. Eckardt scores at this time ranged from 0 to 6. Symptom recurrence was worse for patients with BMI > 40 kg/m2 compared to patients with BMI < 40 kg/m2. BMI was largely unchanged at long-term follow-up regardless of pre-intervention BMI. Most patients were satisfied with surgery but would have considered a combined LHMDF and weight-loss procedure had it been offered. Conclusion LHMDF for achalasia in obese patients is safe and effective in the short term. At long-term follow-up, many patients had symptom recurrence and experienced minimal weight loss. Discussing weight-loss surgery at the time LHMDF may be appropriate to ensure long-term achalasia symptom relief. Keywords Achalasia . Obesity . Laparoscopic Heller myotomy . Bariatric surgery . Short- and long-term outcomes Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01912-0) contains supplementary material, which is available to authorized users. * Jon M. Harrison
Stephanie L. Rakestraw [email protected] Stephen M. Doane [email protected] Michael J. Pucci [email protected] Francesco Palazzo [email protected] Karen A. Chojnacki [email protected] 1
Department of General Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA
2
Boston, USA
Introduction Achalasia is an uncommon esophageal motility disorder that affects 0.5 to 1.6 per 100,000 individuals per year [1]. Achalasia often presents with weight loss, progressive dysphagia for solids and liquids, regurgitation, and retrosternal chest pain, and its diagnosis is based upon these symptoms as well as imaging or endoscopic studies such as barium swallow or manometry [2]. Important manometry findings for achalasia patients include elevated lower esophageal sphincter (LES) pressure and improper body peristalsis or spastic contractions [1, 3]. Al
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