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Introduction <p>Esophagectomy was considered the first line for advanced sigmoid (aSg) achalasia (esophageal angulation &lt; 90°), while laparoscopic Heller myotomy (LHM) has a lower percentage of success. The pull-down LHM (PD-LHM) technique has emerged as a promising and more effective rescue therapy to avoid esophagectomy for aSg achalasia. However, the long-term functional results of PD-LHM are inconclusive.</p> Objective <p>To compare the outcome of aSg achalasia (&lt; 90°) who underwent the PD-LHM technique with those of non-advanced (naSg) achalasia (≥ 90°) and LHM.</p> Patients and methods <p>This ambispective nested cohort study evaluated 34 achalasia patients with megaesophagus divided into two groups: (a) aSg (&lt; 90°; <i>n</i> = 20; 59%) PD-LHM treated, and (b) naSg (≥ 90°; <i>n</i> = 14; 41%) LHM treated. The assessments included esophageal angulation and symptom questionnaires. All patients were clinically and manometrically evaluated before and at 1- and 12-month post-surgery intervals. Clinical outcomes focused on achieving esophageal angulation ≥ 90° and an Eckardt score &lt; 3.</p> Results <p>65% of patients were men, and 65% had achalasia type I. The mean esophageal angulation in aSg was 79.6 ± 8.8°, and in naSg was 116.3 ± 16.3°. aSg improved to 99.5 ± 15.2°, and 17/20 patients (85%) shifted to the naSg group. aSg significantly improved in Eckard symptom score at 1&#xa0;month (1.2 ± 1.3) vs. preoperative score (8.9 ± 1.6). The three aSg patients who experienced PD-LHM failure were male, type I achalasia, had higher preoperative IRP and LES pressure, were older, and had longer disease duration vs. success. A good clinical and manometric outcome was obtained in 85% of aSg.</p> Conclusion <p>Our findings suggest that PD-LHM is an effective treatment for aSg with a success rate of 85%.</p>

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Pull-down Heller myotomy improves the clinical outcome of advanced sigmoid achalasia

  • 期刊论文

  • 发表日期：

    2025年9月5日

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  • Dulce Paola Méndez-Hernández,
  • Miguel Moreno-Fuentes,
  • Natalia Maria Barron-Cervantes,
  • Andres Stenner-Escalante,
  • Carlos Alejandro Morales-Herrera,
  • Diana Aguilar-León,
  • Luis Gerardo López-Mosqueda,
  • Carlos Damián Romero-Osorio,
  • Enrique Coss-Adame,
  • Miguel A. Valdovinos,
  • Luis Raúl Valdovinos-García,
  • Janette Furuzawa-Carballeda,
  • Gonzalo Torres-Villalobos

摘要

Introduction

Esophagectomy was considered the first line for advanced sigmoid (aSg) achalasia (esophageal angulation < 90°), while laparoscopic Heller myotomy (LHM) has a lower percentage of success. The pull-down LHM (PD-LHM) technique has emerged as a promising and more effective rescue therapy to avoid esophagectomy for aSg achalasia. However, the long-term functional results of PD-LHM are inconclusive.

Objective

To compare the outcome of aSg achalasia (< 90°) who underwent the PD-LHM technique with those of non-advanced (naSg) achalasia (≥ 90°) and LHM.

Patients and methods

This ambispective nested cohort study evaluated 34 achalasia patients with megaesophagus divided into two groups: (a) aSg (< 90°; n = 20; 59%) PD-LHM treated, and (b) naSg (≥ 90°; n = 14; 41%) LHM treated. The assessments included esophageal angulation and symptom questionnaires. All patients were clinically and manometrically evaluated before and at 1- and 12-month post-surgery intervals. Clinical outcomes focused on achieving esophageal angulation ≥ 90° and an Eckardt score < 3.

Results

65% of patients were men, and 65% had achalasia type I. The mean esophageal angulation in aSg was 79.6 ± 8.8°, and in naSg was 116.3 ± 16.3°. aSg improved to 99.5 ± 15.2°, and 17/20 patients (85%) shifted to the naSg group. aSg significantly improved in Eckard symptom score at 1 month (1.2 ± 1.3) vs. preoperative score (8.9 ± 1.6). The three aSg patients who experienced PD-LHM failure were male, type I achalasia, had higher preoperative IRP and LES pressure, were older, and had longer disease duration vs. success. A good clinical and manometric outcome was obtained in 85% of aSg.

Conclusion

Our findings suggest that PD-LHM is an effective treatment for aSg with a success rate of 85%.