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Background <p>The choice of anti-reflux procedure with Laparoscopic Heller’s myotomy (LHM) is debatable. LHM with Dor’s fundoplication is the most common procedure performed and has shown similar outcomes to LHM with Toupet’s fundoplication and LHM with Angle of His accentuation (AOH). The present study describes the mid-term outcomes comparing LHM with AOH and LHM with Toupet’s fundoplication.</p> Methods <p>Eighty-six patients who underwent LHM-AOH (group A, <i>n</i> = 43), versus LHM-Toupet’s fundoplication (group B, <i>n</i> = 43) for achalasia cardia were followed up for symptomatic improvement (Eckardt score, ES ≤ 3), improvement in Achalasia disease specific health related quality of life (ADsQoL) and clinical reflux (DeMeester’s heartburn score ≥ 2, and esophagitis on endoscopy).</p> Results <p>At a median duration of 52.5 (IQR 34–67) months, mean ES in both groups decreased (7.42 to 1.2, <i>p</i> &lt; 0.00001, group A and 7.37 to 1.23, <i>p</i> &lt; 0.00001, group B) with no difference among the two groups. Mean ADsQoL scores decreased in both groups significantly (23.3 to 13.7, <i>p</i> &lt; 0.00001, group A and 23.2 to 13.3, <i>p</i> &lt; 0.00001, group B) with the mean ADsQoL scores at the last follow-up being statistically similar in both the groups (<i>p</i> = 0.93). Clinically significant heartburn was seen in 5 (11.6%) and 7 (16.3%) patients in group A and B, respectively (<i>p</i> = 0.76). Ninety-one and 95% patients in group A and B, respectively, had good to excellent satisfaction. Follow-up UGIE (median: 12&#xa0;months) could be performed in 33 (group A) and 28 patients (group B), with 9 (27%) patients in group A and 4 (14.3%) patients in group B showing LA-A or B esophagitis (<i>p</i> = 0.22). No patient had LA-C/D esophagitis. Frequent use of proton pump inhibitors was there by 5 patients in each group (11.6%).</p> Conclusion <p>LHM-AOH and LHM-Toupet’s fundoplication are comparable with respect to symptomatic relief, improvement in quality of life and clinical reflux rates.</p> Graphical abstract <p></p>

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Mid-term outcomes of the patients of achalasia cardia undergoing laparoscopic Heller’s myotomy with angle of his accentuation versus laparoscopic Heller’s myotomy with Toupet’s fundoplication

  • 期刊论文

  • 发表日期：

    2025年6月25日

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  • Sonali Mittal,
  • Aditya Kumar,
  • Manjunath Bale,
  • Vitish Singla,
  • Govind Makharia,
  • Deepak Gunjan,
  • Rajinder Parshad

摘要

Background

The choice of anti-reflux procedure with Laparoscopic Heller’s myotomy (LHM) is debatable. LHM with Dor’s fundoplication is the most common procedure performed and has shown similar outcomes to LHM with Toupet’s fundoplication and LHM with Angle of His accentuation (AOH). The present study describes the mid-term outcomes comparing LHM with AOH and LHM with Toupet’s fundoplication.

Methods

Eighty-six patients who underwent LHM-AOH (group A, n = 43), versus LHM-Toupet’s fundoplication (group B, n = 43) for achalasia cardia were followed up for symptomatic improvement (Eckardt score, ES ≤ 3), improvement in Achalasia disease specific health related quality of life (ADsQoL) and clinical reflux (DeMeester’s heartburn score ≥ 2, and esophagitis on endoscopy).

Results

At a median duration of 52.5 (IQR 34–67) months, mean ES in both groups decreased (7.42 to 1.2, p < 0.00001, group A and 7.37 to 1.23, p < 0.00001, group B) with no difference among the two groups. Mean ADsQoL scores decreased in both groups significantly (23.3 to 13.7, p < 0.00001, group A and 23.2 to 13.3, p < 0.00001, group B) with the mean ADsQoL scores at the last follow-up being statistically similar in both the groups (p = 0.93). Clinically significant heartburn was seen in 5 (11.6%) and 7 (16.3%) patients in group A and B, respectively (p = 0.76). Ninety-one and 95% patients in group A and B, respectively, had good to excellent satisfaction. Follow-up UGIE (median: 12 months) could be performed in 33 (group A) and 28 patients (group B), with 9 (27%) patients in group A and 4 (14.3%) patients in group B showing LA-A or B esophagitis (p = 0.22). No patient had LA-C/D esophagitis. Frequent use of proton pump inhibitors was there by 5 patients in each group (11.6%).

Conclusion

LHM-AOH and LHM-Toupet’s fundoplication are comparable with respect to symptomatic relief, improvement in quality of life and clinical reflux rates.

Graphical abstract