Laparoscopic Heller-Dor for esophagogastric obstruction yields excellent success rates
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Laparoscopic Heller-Dor was effective for the treatment of esophagogastric junction outflow obstruction, according to a study published in the Journal of Gastrointestinal Surgery.
“We are nonetheless convinced that [Laparoscopic Heller-Dor (LHD)] could be an effective treatment for [esophagogastric junction outflow obstruction (EGJOO)], comparable with what the same procedure can achieve in early-stage achalasia,” Renato Salvador, MD, from the department of surgical, oncological and gastroenterological sciences at the University of Padova, School of Medicine, University of Padova, Italy, and colleagues wrote. “Further studies with longer follow-up and a larger cohort of EGJOO patients need to confirm our results.”
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Salvador and colleagues compared 25 patients with EGJOO who underwent LHD and 125 with radiological stage I achalasia. Researchers further analyzed patients in the achalasia group based on the manometric pattern. Medium follow-up was 24 months.
“Treatment failure was defined as the persistence or reoccurrence of an Eckardt score [greater than] 3 or the need for retreatment,” Salvador and colleagues wrote.
In the EGJOO group, LHD was successful in 96% of patients. LHD was also successful in 96% of achalasia patients with pattern I, 98.7% in those with pattern II, and 96.2% of those with pattern III (P = .5).
According to researchers, high-resolution manometry demonstrated a decrease in the lower esophageal sphincter resting pressure and integrated relaxation pressure for all patients in all groups (P < .001).
“LHD should be offered to EGJOO patients in dedicated center only, with great experience with this operation and esophageal diseases,” the investigators wrote. “Additional studies might better pinpoint EGJOO patients and help us to establish whether this condition is a variant or an early stage of achalasia.”
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