176. the surgical outcomes of laparoscopic heller cardiomyotomy and dor fundoplication for achalasia

Abstract Esophageal cardiomyotomy is the main component of treatment in achalasia which can be performed endoscopically or by surgery. Laparoscopic esophageal cardiomyotomy for achalasia is associated with reduced early postoperative morbidity compared to open surgery whilst laparoscopic anterior fundoplication is associated with reduced postoperative reflux symptoms. Proton Pump Inhibitor (PPI) is usually prescribed for postoperative acid reflux symptoms. The outcomes of laparoscopic Heller cardiomytomy and Dor fundoplication (LHCDF) from our unit were analyzed. Consecutive cases of achalasia who underwent LHCDF were identified from electronic medical records from June 2016 to December 2021. The preoperative assessment included esophagogastroduodenoscopy (EGD), oral contrast swallow (OCS), esophageal high-resolution manometry (HRM) and occasionally a computed tomography scan. Objective symptoms evaluation using Eckardt score was performed before and after surgery. Long myotomy was performed with 7 cm on esophageal and 2 cm on gastric side followed by 3-stitches on each side of Dor fundoplication. Intraoperative EGD and postoperative OCS was routinely performed. The surgical outcomes of LHCDF were analyzed. There were 11 cases of LHCDF with the mean age of 50 ± 5 years and M:F ratio 4:7. HRM confirmed 1 Type-I and 8 Type-II achalasia. The mean preoperative Eckardt score was 7.2 ± 0.5 and postoperative score of 0.5 ± 0.2. The mean duration of operation was 206 ± 7 minutes. There were no surgery-related complications, readmission, or mortality. The mean length of stay was 3 ± 0.5 days. Postoperative PPI use for acid reflux symptoms was 19% (n = 2). EGD at 1 year showed 1 esophagitis. The mean duration of clinic follow up was 24.6 ± 5.4 months. LHCDF achieved good symptoms relief and surgical outcomes in patients with symptomatic achalasia. In this small cohort and short-term follow up, the majority of post-LHCDF patients did not require PPI for acid reflux symptoms and none required endoscopic or surgical reintervention.