Laparoscopic Heller myotomy relieves dysphagia in patients with achalasia and low LES pressure following pneumatic dilatation.
BACKGROUND
Although pneumatic dilatation is said to relieve dysphagia in achalasia if it decreases lower esophageal sphincter (LES) pressure to 10 mmHg (n = 23); group C, no previous balloon dilatation and LES pressure >10 mmHg (n = 25). All patients underwent a laparoscopic Heller myotomy and Dor fundoplication. The severity of dysphagia was gauged on a scale of 0-4.


RESULTS
In group A, LES pressure was 7 +/- 2 mmHg preoperatively and 8 +/- 3 mmHg postoperatively; the dysphagia score was 3.3 +/- 0.7 preoperatively and 0.9 +/- 1.1 postoperatively. Eighty-nine percent of patients had excellent or good results. In group B, LES pressure was 23 +/- 8 mmHg preoperatively and 10 +/- 1 mmHg postoperatively; the dysphagia score was 3.3 +/- 0.7 preoperatively and 0.3 +/- 0.5 postoperatively. All patients had excellent or good results. In group C, LES pressure was 23 +/- 11 mmHg preoperatively and 14 +/- 12 mmHg postoperatively; the dysphagia score was 3.6 +/- 0.6 preoperatively and 0.2 +/- 0.5 postoperatively. All patients had excellent or good results.


CONCLUSIONS
These results show that (a) a LES pressure of <10 mmHg after pneumatic dilatation does not guarantee relief of dysphagia, and (b) laparoscopic Heller myotomy relieves dysphagia in most patients with a postdilatation LES pressure <10 mmHg. Thus, a laparoscopic Heller myotomy is indicated if dilatation does not relieve dysphagia, even if LES pressure has been decreased to <10 mmHg. Esophagectomy should be reserved for the occasional failure of this simpler operation.
Diener
U
U
Department of Surgery, University of California, 533 Parnassus Avenue, San Francisco, CA 94143-0788, USA.
Patti
M G
MG
Molena
D
D
Tamburini
A
A
Fisichella
P M
PM
Whang
K
K
Way
L W
LW
D000293:Adolescent; D000328:Adult; D000368:Aged; D001466:Barium Sulfate; D002404:Catheterization / Q000379:methods*; D003680:Deglutition Disorders / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy*; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009130:Muscle, Smooth / Q000503:physiopathology / Q000601:surgery; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome
D001466:Barium Sulfate