Results of laparoscopic Heller esophagocardiomyotomy with Dor fundoplication in patients with stages 3 and 4 of the esophageal achalasia

INTRODUCTION. The choice of a treatment method in patients with stages 3–4 of the esophageal achalasia remains an actual topic.

The OBJECTIVE was to evaluate the long-term results of Heller esophagocardiomyotomy with Dor hemiesophagofundoplication at stages 3–4 of the esophageal achalasia by comparing the results of patient survey with data of instrumental methods of diagnosis of esophageal function.

METHODS AND MATERIALS. The results of the operation were analyzed in 67 patients, including 35 patients with stage 3 and 32 patients with stage 4 of the disease. The period of postoperative follow-up was 1–5 years. The results of X-ray examination of the esophagus and stomach, esophageal manometry, 24-hour pH-metry and the data of the Eckardt and GIGLI scale questionnaires were evaluated.

RESULTS. The data of X-ray examination of the esophagus and stomach, in the long-term period, showed a complete restoration of the esophagus evacuation function in all patients (p=0.001), according to manometric data, a significant decrease in the tone of the lower esophageal sphincter in all patients to normal values (p=0,001) was revealed, esophageal atony was noted in three patients with stage 4 of the disease. Pathological gastroesophageal reflux before and after surgery was not registered by pH-metry, the De Meester index was within the normal range in all groups (less than 14.72). Dysphagia in the long-term period decreased in all patients. Long-term results on the Eckardt scale in patients with stage 3 improved by 83.5 %, with stage 4 by 78.3 % (p=0.001), according to the GIGLI questionnaire, patients with stage 3 scored 83.5 %, with stage 4 by 78.3 % more than before surgery.

CONCLUSION. Laparoscopic Heller esophagocardiomyotomy with Dor fundoplication reduces symptoms of the disease in patients with stages 3–4 of the esophageal achalasia, increases the gastrointestinal index of quality of life, which makes it advisable to perform organ-preserving surgery at stage 4 of the disease.

1. Ajani J. A., D’Amico T. A., Bentrem D. J. et al. Esophageal and Esophagogastric Junction Cancers, Version 2.2019, NCCN Clinical Prac tice Guidelines in Oncology // J Natl Compr Canc Netw. 2019. Vol. 17, № 7. P. 855–883. Doi: 10.6004/jnccn.2019.0033.

2. Mundre P., Black C. J., Noor M., Ford A. C. Efficacy of surgical or endoscopic treatment of idiopathic achalasia: a systematic review and network meta-analysis // The Lancet. 2021;6(Issue 1):30–38. Doi.org/10.1016/S2468-1253(20)30296-X.

3. Anipchenko A. N., Allahverdyan A. S. Diagnosis and Treatment of Cardiac Achalasia: Clinical Lecture // Моscоw Surgical Journal. 2018;4;5–13. Doi: 10.17238/issn2072-3180.2018.4.5-13. (In Russ.).

4. Petrovsky B. V. Cardiospasm and its surgical significance // Proceedings of the 27th All-Union Congress of Surgeons. Moscow, 1962:162–173. (In Russ.).

5. Scott P. D., Harold K. L., Heniford R. B. T., Jaroszewski D. E. Results of laparoscopic Heller myotomy for extreme megaesophagus: an alternative to esophagectomy // Surg Laparosc Endosc Percutan Tech. 2009;19(3):198–200. Doi: 10.1111/j.1445-2197.2006.03784.x .

6. Nizamkhodjaev Z. M., Ligay R. E., Tsoy A. O. et al. Experience of application of minimally invasive methods of treatment patients with launched stages of achalasia // Issues of Reconstructive and Plastic Surgery. 2020;23(2);49–57. Doi: 10.17223/1814147/73/06. (In Russ.).

7. Watson T. J. Esophagectomy for end-stage achalasia // World J Surg. 2015;39(7):1634–1641. Doi:10.1007/s00268-015-3012-x.