Evaluating Long-term Results Of Transabdominal Modified Heller Myotomy And Dor Fundoplicati-on In People With Achalasia

Objective:To report the long-term outcomes of transabdominal modified Heller myotomy combined with Dor fundoplication surgery.Methods:28patients who underwent transabdominal modified Heller combined with Dor surgery from June2001to August2009were reviewed.Dysphagia score,barium esophagogram,flexible upper alimentary endoscopy,24-hour esophageal pH monitoring,and esophageal manometry before and after surgeiy were analyzed.The mean duration of follow-up after surgery was5.12years, ranging from (3-9) years.Results:11males and17females were followed.The mean age was43.46years(24-71).Preoperatively,the most common symptom was dysphagia(100%) and the interval between beginnings of symptoms to a definitive diagnosis was (4.30±5.83) years.28patients underwent surgery successfully.And there were no operative deaths or serious complications.All patients were able to eat semifluid or solid food without dysphagia and acid reflux at discharge.The mean operation time ranged from60and100minutes with the bleeding volumes between10to50ml,and none of the patients needed blood transfusion intraoperatively.The postoperative hospital stay was (9.04±1.57) days (range7-12).Postoperatively,a satisfactory outcome was observed in25(89.29%) patients in the long-term follow-up.Only3patients had mild dysphagia without requiring treatment.The incidence rate of acid reflux was10.71%(3/28),1of the3patients had serious heartburn in the6years after operation.Endoscopically,7.69%(2/26) was considered as mild-moderate erosive esophagitis.Dysphagia score, barium esophagogram, esophageal manometry and24-hour pH monitoring were performed at follow-up in28,28,23and23patients,respectively.The mean dysphagia score before surgery was6.50points,and after surgery,1.18points (maximum of10points),P<0.001.The barium esophagogram showed a significant decrease(from3.46±1.16to1.88±0.93cm,P<0.001)of maximum esophageal diameter,as compared with preoperative values. Esophageal manometry revealed that the lower esophageal sphincter resting pressure decreased 10.07mmHg in the wake of the procedure(P<0.001).24-hour pH monitoring showed4patients had abnormal Demeester scores and confirmed pathological gastroesophageal reflux existed in2of23patients(8.69%).Conclusion:Open transabdominal modified Heller and Dor is an effective and safe procedure of esophageal achalasia in people because of its long-term high rate of symptoms relief and low incidence of postoperative acid reflux.Through two aspects of subjective symptoms and objective indicators,we can confirm a satisfactory result of the surgery more adequately.