1. Context and Issues
1.1. ''Failure to Relax'' or Achalasia
Achalasia is a relatively rare esophageal motility disorder; its pathogenesis is presumed to be idiopathic or infectious neurogenic degeneration. Achalasia is also known to be a premalignant condition of the esophagus. The available therapies (surgical or endoscopic myotomy and pneumatic dilation) are considered only palliative [1,2]. In the surgical literature, the results of laparoscopic achalasia treatment are generally consistent, with good outcomes reported in 85 to 95 % of patients at 5-year follow-up [3-7]. The most common complication after Laparoscopic Heller-Dor (LHD) is Gastroesophageal Reflux Disease (GERD) (6-34 %) [8-11].
2. Study Objectives
2.1. General Objective
Highlight the drawbacks of laparoscopic Heller Dor myotomy and offer new surgical options for treating Achalasia.
2.2. Specific Objectives
· Asses complications rate after the regular Heller Dor Myotomy.
· Demonstrate a new surgical technique for treating Achalasia.
· Comparison of long term outcomes post regular Heller Dor and the modified one.
3. Methodological Approach
It is an observational prospective study from January 2010 to January 2018 in three different hospitals Al zahraa, Bahman and Rasoul al aazam.
4. Data Collection
4.1. Inclusion Criteria
All consecutive patients with a definitive diagnosis of achalasia who underwent modified laparoscopic Heller-Dor.
4.2. Exclusion Criteria
· Patients who don't have a real diagnosis of achalasia.
· patients who has operated with other surgical or non-surgical technique.
All patients who had achalasia and operated with laparoscopic Heller-Dor and had no documented symptoms or redo surgery.
The following variables will be included: patient’s data (age, gender, comorbidities), preoperative symptoms (dysphagia, chest pain, regurgitation, and heartburn), indication for surgery, postoperative follow-up (heartburn, dysphagia, stenosis, perforation, bleeding, infection).
6. Data Analysis
The incidence of achalasia recurrence will be calculated. A multivariate analysis will be performed looking for most common complications.
7. Impact of The Study
The aim of this study is to prove that the modified Heller Dor Myotomy for treating Achalasia has improved outcomes over the regular myotomy; GERD in specific.
- Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, et al. (2009) Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg 249: 45-57.
- Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, et al. (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240: 405-412.
- Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, et al. (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248: 986-993.
- Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, et al. (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230: 587-593.
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- Vela MF, Richter JE, Khandwala F, Blackstone EH, Wachsberger D, et al. (2006) The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clini Gastroenterol Hepatol 4: 580-587.
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