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Laparoscopic Heller's cardiomyotomy: a viable treatment option for sigmoid oesophagus
Karthik Panchanatheeswaran1, Rajinder Parshad, Jitender Rohila
1Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.
Insights
Laparoscopic Heller
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Esophageal Motility Disorders
Background:
- Sigmoid esophagus, a severe form of achalasia, traditionally requires esophagectomy.
- Heller's cardiomyotomy (HCM) is often considered ineffective for sigmoid esophagus due to esophageal dilation and axis deviation.
Purpose of the Study:
- To evaluate the efficacy of laparoscopic Heller's cardiomyotomy (HCM) with an antireflux procedure in managing sigmoid esophagus.
- To assess symptom improvement and quality of life in patients with sigmoid esophagus undergoing laparoscopic HCM.
Main Methods:
- Retrospective review of 8 patients with sigmoid esophagus who underwent laparoscopic HCM and an antireflux procedure.
- Preoperative and postoperative assessment of esophageal symptoms, respiratory symptoms, and quality of life scores.
Main Results:
- Significant improvement in dysphagia (P=0.014) and regurgitation (P=0.008) scores post-surgery.
- Marked improvement in quality of life (P=0.005) and complete resolution of chronic cough in 4 patients.
- No mortalities or major complications; mean operative time was 203.7 minutes.
Conclusions:
- Laparoscopic HCM with an antireflux procedure offers significant symptom relief for sigmoid esophagus.
- This approach may serve as a primary treatment option, reserving esophagectomy for failed cardiomyotomy cases.
Objectives:
It is generally believed that Heller's cardiomyotomy (HCM) cannot improve dysphagia in patients with marked dilatation and axis deviation or sigmoid oesophagus. Conventional management for sigmoid oesophagus has been oesophagectomy. We report our surgical experience in the management of 8 patients with sigmoid oesophagus with laparoscopic HCM.
Methods:
Eight patients with sigmoid oesophagus were retrospectively identified and their records were reviewed for symptomatic outcome evaluation following laparoscopic HCM with an antireflux procedure. Preoperative and postoperative, oesophageal and respiratory symptoms and quality of life scoring of achalasia were recorded.
Results:
The mean age was 35.5 (range 25-57) years. Males and females were equally distributed. All patients had dysphagia as their chief presenting complaint. The median duration of dysphagia was 55 (range 18-180) months. All the patients had a poor quality of life. Four patients also had chronic cough. All 8 patients underwent laparoscopic HCM with an antireflux procedure. The mean duration of operation was 203.7 min. There were no mortalities and no major postoperative complications. At a median follow-up of 19.5 (range 6-45) months, there was a significant improvement of dysphagia and regurgitation scores with P-values of 0.014 and 0.008, respectively. Quality of life also significantly (P = 0.005) improved post-surgery. Chronic cough resolved in all the 4 patients (100%) following cardiomyotomy.
Conclusions:
Laparoscopic HCM with an antireflux procedure provides significant symptom relief in patients with sigmoid oesophagus and may be considered as the first-line treatment option in such patients. Oesophagectomy should be reserved for patients with a failed cardiomyotomy.
