title: Postoperative Gastroesophageal Reflux After Laparoscopic Heller-Dor for Achalasia: True Incidence with an Objective Evaluation.
abstract: The most common complication after laparoscopic Heller-Dor (LHD) is gastroesophageal reflux disease (GERD). The present study aimed (a) to analyze the true incidence of postoperative reflux by objectively assessing a large group of LHD patients and (b) to see whether the presence of typical GERD symptoms correlates with the real incidence of postoperative reflux.
  
  
  
  After LHD, patients were assessed by means of a symptom score, endoscopy, esophageal manometry, and 24-h pH monitoring. Patients were assigned to three groups: those did not accept to perform 24-h pH monitoring (group NP); those with normal postoperative pH findings (group A); and those with pathological postoperative acid exposure (group B).
  
  
  
  Four hundred sixty-three of the 806 LHD patients agreed to undergo follow-up 24-h pH monitoring. Normal pH findings were seen in 423 patients (group A, 91.4 %), while 40 (8.6 %) had a pathological acid exposure (group B). The median symptom scores were similar: 3.0 (IQR 0-8) in group A and 6.0 (IQR 0-10) in group B (p = 0.29). At endoscopy, the percentage of esophagitis was also similar (11 % in group A, 19 % in group B; p = 0.28).
  
  
  
  This study demonstrated that, after LHD was performed by experienced surgeons, the true incidence of postoperative GERD is very low. The incidence of this possible complication should be assessed by pH monitoring because endoscopic findings and symptoms may be misleading.
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy. renato.salvador@libero.it.
authors.forename: Renato
authors.identifier: 0000-0002-3281-0361
authors.initials: R
authors.lastname: Salvador
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Pesenti
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Gobbi
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capovilla
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spadotto
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Guerrino
authors.initials: G
authors.lastname: Voltarel
authors.affiliation: Surgical Oncology Unit, Veneto Institute of Oncology (IOV IRCCS), Padova, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Nicoletti
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Valmasoni
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruol
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Merigliano
authors.affiliation: Department of Surgical, Oncological and Gastroenterological Sciences, School of Medicine, University of Padova, Clinica Chirurgica 3, Policlinico Universitario, Padova, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Costantini
mesh_terms: D000328:Adult; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D006801:Humans; D015994:Incidence; D010535:Laparoscopy; D008297:Male; D008365:Manometry; D008875:Middle Aged
keywords: Achalasia; GERD; Gastroesophageal reflux; Heller myotomy