Comparison between Outcome after Laparoscopic Heller’s Myotomy with Dor Fundoplication in Patients Who Had or Had Not Undergone Previous Trials of Endoscopic Balloon Dilatation for Cardiac Achalasia

Abstract

chalasia is a primary esophageal motor disorder of unknown etiology characterized manometrically by insufficient relaxation of the lower esophageal sphincter (LES) and loss of esophageal peristalsis, radiographically by aperistalsis, esophageal dilation, with minimal LES opening, “bird-beak” appearance, poor emptying of barium; and endoscopically by dilated esophagus with retained saliva, liquid, and undigested food particles in the absence of mucosal structuring or tumor. Achalasia is a chronic condition without cure. Current treatments options in achalasia are aimed at reducing the hypertonicity of the LES by pharmacologic, endoscopic, or surgical means. No intervention significantly affects esophageal peristalsis, and despite therapeutic interventions the LES hypertonicity returns over time, requiring repeat interventions. LHM+DF has become a standard treatment for achalasia. It offers low morbidity rates, long symptoms relief and good quality of life. The best result of DF is because it is characterized by a smaller dissection in the hiatal region and provides an anchorage of the margins of the myotomy, and then it keeps them apart during healing, preventing excessive scar shrinkage. Caution should be exercised to deciding indication of balloon dilatation, because it negatively impacts LHM+DF through increased operative time and increased adhesions at the gastro-oesophageal junction.