Laparoscopic Heller myotomy and anterior Dor fundoplication for achalasia cardia in Malaysia: Clinical outcomes and satisfaction from four tertiary centers.
BACKGROUND
To evaluate the clinical outcomes and satisfaction of patients following laparoscopic Heller myotomy for achalasia cardia in four tertiary centers.


METHODS
Fifty-five patients with achalasia cardia who underwent laparoscopic Heller myotomy between 2010 and 2019 were enrolled. The adverse events and clinical outcomes were analyzed. Overall patient satisfaction was also reviewed.


RESULTS
The mean operative time was 144.1 ± 38.33 min with no conversions to open surgery in this series. Intraoperative adverse events occurred in 7 (12.7%) patients including oesophageal mucosal perforation (n = 4), superficial liver injury (n = 1), minor bleeding from gastro-oesophageal fat pad (n = 1) & aspiration during induction requiring bronchoscopy (n = 1). Mean time to normal diet intake was 3.2 ± 2.20 days. Mean postoperative stay was 4.9 ± 4.30 days and majority of patients (n = 46; 83.6%) returned to normal daily activities within 2 weeks after surgery. The mean follow-up duration was 18.8 ± 13.56 months. Overall, clinical success (Eckardt ≤ 3) was achieved in all 55 (100%) patients, with significant improvements observed in all elements of the Eckardt score. Thirty-seven (67.3%) patients had complete resolution of dysphagia while the remaining 18 (32.7%) patients had some occasional dysphagia that was tolerable and did not require re-intervention. Nevertheless, all patients reported either very satisfied or satisfied and would recommend the procedure to another person.


CONCLUSIONS
Laparoscopic Heller myotomy and anterior Dor is both safe and effective as a definitive treatment for treating achalasia cardia. It does have a low rate of oesophageal perforation but overall has a high degree of patient satisfaction with minimal complications.
['Siow|Sze Li|SL|', 'Mahendran|Hans Alexander|HA|', 'Najmi|Wan Daud|WD|', 'Lim|Shyang Yee|SY|', 'Hashimah|Abdul Rahman|AR|', 'Voon|Kelvin|K|', 'Teoh|Keat How|KH|', 'Boo|Han Sin|HS|', 'Chuah|Jun Sen|JS|', 'Nurazim|Sidi|S|', 'Faqihuddin|Mohamad Hisham|MH|']
D000328:Adult D000368:Aged D003680:Deglutition Disorders D004931:Esophageal Achalasia D004939:Esophageal Perforation D005260:Female D005500:Follow-Up Studies D000074434:Heller Myotomy D006801:Humans D007431:Intraoperative Complications D010535:Laparoscopy D008296:Malaysia D008297:Male D008875:Middle Aged D017060:Patient Satisfaction D012449:Safety D062606:Tertiary Care Centers D013997:Time Factors D016896:Treatment Outcome
Myotomy Achalasia Dysphagia Heller-Dor