title: Laparoscopic Heller-Dor for primary esophageal achalasia: outcomes in 173 patients.
abstract: OBJECTIVE
  Laparoscopic Heller myotomy combined with anterior (Dor) fundoplication is the most widely-used surgical procedure for treating esophageal achalasia in Europe
  
  
  METHODS
  From November 1992 through May 2010 we performed laparoscopic Heller-Dor on 173 patients
  
  
  RESULTS
  Conversion to laparotomy was required in three cases (1.7%) at the beginning of the experience (for mucosal) perforation which was the most frequent intraoperative complication, managed laparoscopically with the increasing experience. Five (2.9%) cases had minor postoperative complications. Clinical results were satisfactory in 99.4% of cases. One patient (0.6%) had severe persistent dysphagia. Mean esophageal diameter decreased from 50 mm ± 12 (range 20- 90) to 25 mm ± 7 (range 15-80). Lower esophageal sphincter pressure decreased from 32 mmHg (median, range 10- 93) pre-operatively to 11 mmHg (median, range 5-21) at one year follow up and residual pressure from 12 mmHg (median, range 3-30) to 4 mmHg (median, range 1-8). Impedance and pH monitoring showed normal levels in 39/47 (83%) patients who agreed to testing.
  
  
  CONCLUSIONS
  The good outcomes of this experience, in part due to careful adherence to technical aspects of the operation, confirm that the laparoscopic Heller-Dor is the gold standard surgical treatment for esophageal achalasia.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
authors.forename: Uberto
authors.initials: U
authors.lastname: Fumagalli Romario
authors.forename: Martina
authors.initials: M
authors.lastname: Ceolin
authors.forename: Simonetta
authors.initials: S
authors.lastname: Massaron
authors.forename: Alberto
authors.initials: A
authors.lastname: Peracchia
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult