title: The influence of operation technique on long-term results of achalasia treatment.
abstract: Currently, the most effective therapy for achalasia is laparoscopic Heller myotomy with partial fundoplication. The aim of this study was to compare the long-term results between 2 different laparoscopic operation techniques in achalasia treatment.
  
  
  METHODS
  This was a retrospective study, where 46 achalasia patients were examined: 23 patients underwent laparoscopic Heller myotomy followed by the full gastric fundus mobilization, total hiatal dissection, and posterior Toupet (270°) fundoplication (group 1); other 23 patients underwent laparoscopic Heller myotomy with limited surgical cardia region dissection, not dividing the short gastric vessels and performing anterior partial Dor fundoplication (group 2). Long-term findings included the evaluation of postoperative dysphagia according Vantrappen and Hellemans and intensity of heartburn according the standard grading system.
  
  
  RESULTS
  The patients in these 2 groups were similar in terms of age, weight, height, and postoperative hospital stay. The median follow-up was 66 months in the group 1 and 39 months in the group 2 (P<0.05). Laparoscopic operation was effective in 82.6% of patients (excellent and good results) in the group 1; treatment was effective in 78.3% of patients in the group 2 (P>0.05). Clinically significant heartburn was documented in 39% of patients in the group 1 and only in 13% of patients in the group 2 (P<0.05).
  
  
  CONCLUSIONS
  According our study results, both laparoscopic techniques were similarly effective (82.6% vs. 78.3%) in achalasia treatment. Postoperative heartburn was significantly more common (39% vs. 13%) after laparoscopic myotomy, followed by the full gastric fundus mobilization, total hiatal dissection, and posterior Toupet (270°) fundoplication.
authors.affiliation: Department of Surgery, Me-dical Academy, Lithuanian University of Health Sciences, Ei-ve-nių 2, 50028 Kaunas, Lithuania. minkiud@yahoo.com
authors.forename: Mindaugas
authors.initials: M
authors.lastname: Kiudelis
authors.forename: Kristina
authors.initials: K
authors.lastname: Mechonosina
authors.forename: Antanas
authors.initials: A
authors.lastname: Mickevičius
authors.forename: Almantas
authors.initials: A
authors.lastname: Maleckas
authors.forename: Žilvinas
authors.initials: Ž
authors.lastname: Endzinas
mesh_terms: D000328:Adult; D000368:Aged; D002299:Cardia / Q000601:surgery; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D018662:Fundoplication / Q000379:methods*; D006356:Heartburn / Q000209:etiology / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult