Comparison between initial laparoscopic surgery and laparoscopic surgery following balloon dilation for esophageal achalasia

Abstract

Purpose : A retrospective study was made to elucidate the effect of previous history of balloon dilatation on laparoscopic Heller myotomy and Dor fundoplication (LHD) in patients with achalasia. Subjects and methods : We enrolled 25 patients undergone LHD operations for achalasia in our hospital from July 2003 to December 2006. Fifteen patients of them underwent LHD as an initial treatment (LHD-first group), and the remaining 10 patients had the previous history of balloon dilatation prior to LHD with unsatisfactory outcome (BD-first group). Perioperative complications and long-term outcomes were compared between the two groups. Results : The operation time of the BD-first group was significantly longer than that of the LHD-first group (p=0.021). Injury of the esophageal mucosa during myotomy was recognized in three patients only in the BD-first group (p=0.037). In the long-term follow-up study, the LHD improved dysphagia in 95 % of all patients and there was no significant difference between the both groups. In one patient from the BD-first group who had sigmoid type achalasia with serious esophageal dilatation, dysphagia persisted after the treatment. Conclusion : the LHD is a reliable method to relive dysphagia in patients with esophageal achalasia. Myotomy following balloon dilation entails a greater risk of injuring the esophageal mucosa. Thus the LHD is desirable as the initial treatment for achalasia.