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Quality of life after Heller-Dor's cardiomyotomy
Fernando A V Madureira1, Fábio A V Madureira, Angelo Bustani Loss
1General Surgery, Universidade Federal do Rio de Janeiro, Brazil. drfmadureira@hotmail.com
Insights
Laparoscopic Heller
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Esophageal achalasia is a motility disorder characterized by impaired esophageal peristalsis and elevated lower esophageal sphincter pressure.
- Surgical interventions aim to relieve dysphagia and improve esophageal emptying.
- Laparoscopic Heller's Cardiomyotomy with Dor fundoplication (HDL) is a minimally invasive approach for achalasia treatment.
Purpose of the Study:
- To evaluate the surgical outcomes of HDL in patients with esophageal achalasia.
- To assess the impact of HDL on patients' quality of life.
- To analyze changes in esophageal manometry data, specifically lower esophageal sphincter pressure (PLES), post-HDL.
Main Methods:
- Retrospective study of 60 patients with achalasia operated on between 2001 and 2007.
- Data collected included demographics, diagnostic test results, and pre- and post-operative dysphagia scores.
- Lower esophageal sphincter pressure (PLES) was measured before and after surgery.
Main Results:
- No mortality or conversions to open surgery were reported.
- Excellent outcomes were achieved in 80% of patients, with a significant improvement in dysphagia scores (mean decrease of 87.17%).
- Mean PLES decreased significantly from 32.41 mmHg pre-operatively to 12.7 mmHg post-operatively.
Conclusions:
- Laparoscopic Heller's Cardiomyotomy with Dor fundoplication (HDL) is a safe and effective procedure for esophageal achalasia.
- HDL significantly improves patients' subjective quality of life by reducing dysphagia.
- The procedure leads to a significant reduction in objective lower esophageal sphincter pressure (PLES).
Objective:
To evaluate the surgical outcomes of Heller's Cardiomyotomy with Dor fundoplication by laparoscopy (HDL) and to assess its impact on patients' quality of life and on esophageal manometry data.
Methods:
60 patients with esophageal achalasia, operated on between 2001 and 2007, were studied retrospectively. Before surgery, the demographics and the diagnostic test results were recorded. The patients submitted a dysphagia score for quality of life before and after surgery, and lower esophageal sphincter pressure (PLES) was measured. We also studied the difference produced in quality of life
Results:
37 women and 23 men were followed. Mean age was 41.08 (12-87). There was no mortality and no conversions. The mean time of diet resumption was 1.6 day. The outcome was considered excellent in 80% of the series and intermediate in 20% of the series. The mean dysphagia score before surgery was 9.03 points, and after surgery, 1.7 point (maximum of 10 points), p=0.0001. The mean score decrease between pre- and postoperative scores was 7.33 points (87.17%). The mean PLES before surgery was 32.41 mmHg, and 12.7 mmHg after.
Conclusion:
HDL is a safe procedure and changed significantly the subjective quality of life scores, as well as the objective PLES means.
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