HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sandro Mattioli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ruffato, A. Articles by Di Simone, M. P. Search for Related Content PubMed PubMed Citation Articles by Ruffato, A. Articles by Di Simone, M. P. Related Collections Esophagus - other

Eur J Cardiothorac Surg 2006;29:914-919
© 2006 Elsevier Science NL

Long-term results after Heller–Dor operation for oesophageal achalasia

^a Division of Oesophageal and Pulmonary Surgery, Villa Maria Cecilia and San Pier Damiano Hospitals, Cotignola and Faenza, Ravenna, Italy
^b Center for the Study and Therapy of Diseases of the Oesophagus (Surgical Section), University of Bologna, Bologna, Italy

Received 16 January 2006; received in revised form 15 March 2006; accepted 20 March 2006.

^_* Corresponding author. Address: Department of Surgery, Intensive care and Organs Transplantation, University of Bologna, S. Orsola-Malpighi University Hospital, Via G. Massarenti 9, 40138 Bologna, Italy. Tel.: +39 051 6364684; fax: +39 051 347431. (Email: sandro.mattioli{at}unibo.it).

Objective: In the literature, reports on the definitive rate of cure of the surgical treatment of oesophageal achalasia are not numerous. The aim of this study is to assess the clinical–instrumental-based patient's outcome related to long-term follow-up. Methods: One hundred and seventy-four patients (80 men, median age 57 years, range 7–83) consecutively submitted to first instance transabdominal Heller–Dor in the period 1978–2002 were considered. Follow-up consisted of clinical interview, endoscopy, barium-swallow and oesophageal manometry if required. Twenty-six cases (15%) were sigmoid achalasias. Results: One patient died post-operatively (severe haemorrhage in a patient previously operated upon for a cardiovascular malformation and suffering for portal hypertension), 173 were followed-up (mean 109 months, range 12–288, median 93 months) of whom 68 for more than 15 years. On the whole 151 patients (87.3%) had satisfactory and 22 (12.7%) had poor long-term results. Seven out of 173 patients (4%), 6 of whom were pre-operatively classified as sigmoid achalasia, subsequently underwent oesophagectomy, 3 for epidermoid cancer, 1 for Barrett's adenocarcinoma, 2 for stasis oesophagitis and recurrent sepsis, 1 for severe dysphagia. Fifteen patients (8.7%) had an insufficient result due to reflux oesophagitis which appeared in 2 (one erosion) after 184 and 252 months. All 22 patients, whether surgically or medically retreated, achieved satisfactory control of dysphagia and reflux symptoms. Conclusions: In the long term, insufficient results strictly related to Heller–Dor failure, always due to reflux oesophagitis, were recorded in 15/173 patients (8.7%) although it is questionable whether reflux oesophagitis appearing after more than 15 years is due to the Dor incompetence or to ageing. In sigmoid achalasia, oesophagectomy rather than myotomy should be taken into consideration in the first instance. In the long-term, surgery is the best definitive treatment for oesophageal achalasia.

Key Words: Oesophageal achalasia • Heller myotomy • Dor antireflux procedure • Long-term results

This article has been cited by other articles:

				E. Faccani, S. Mattioli, M. L. Lugaresi, M. P. Di Simone, T. Bartalena, and V. Pilotti Improving the surgery for sigmoid achalasia: long-term results of a technical detail Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 827 - 833. [Abstract] [Full Text] [PDF]