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[Heller's intervention for esophageal achalasia]

F P Mattioli1, N Pandolfo, L Spigno

  • 1Istituto di Clinica Chirurgica Generale e Terapia Chirurgica, Università degli Studi di Genova.

Annali Italiani Di Chirurgia
|September 1, 1995
PubMed
Summary

Heller

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Area of Science:

  • Gastroenterology and Surgical Innovation
  • Esophageal Motility Disorders Treatment
  • Surgical Outcomes Analysis

Background:

  • Esophageal achalasia is a primary esophageal motility disorder.
  • Surgical myotomy is a common treatment for achalasia.
  • The effectiveness of anti-reflux procedures in conjunction with myotomy requires evaluation.

Purpose of the Study:

  • To compare the long-term outcomes of different surgical approaches for esophageal achalasia.
  • To assess the efficacy of Heller's myotomy with and without anti-reflux procedures.
  • To evaluate the incidence of gastro-esophageal reflux and esophagitis post-surgery.

Main Methods:

  • Retrospective analysis of 63 patients with esophageal achalasia undergoing primary surgical treatment from 1962 to 1992.
  • Three surgical groups: Heller's cardiomiotomy (Group A), Heller's cardiomiotomy with Lortat-Jacob anti-reflux procedure (Group B), and Heller's cardiomiotomy with Dor fundoplicatio (Group C).
  • Preoperative and postoperative evaluations included clinical assessment, endoscopy, esophageal manometry, and pH-monitoring.

Main Results:

  • Good clinical results (minimal dysphagia) were achieved in 70% of Group A, 90% of Group B, and 90% of Group C.
  • Gastro-esophageal reflux symptoms occurred in 15% (Group A), 20% (Group B), and 11% (Group C).
  • Esophagitis rates were 40% (Group A), 50% (Group B), and 18% (Group C), indicating that anti-reflux procedures were not fully effective.

Conclusions:

  • Heller's cardiomiotomy effectively resolves dysphagia in esophageal achalasia.
  • Current anti-reflux procedures, including Dor fundoplicatio, show limited effectiveness in preventing postoperative gastro-esophageal reflux.
  • Further optimization of anti-reflux strategies is needed to reduce complications after achalasia surgery.

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