Background
Achalasia is a rare esophageal motility disorder of unknown cause. However, the best treatment modality for achalasia is controversial. Treatment consists of disruption of the lower esophageal sphincter, classically either by endoscopic pneumatic dilation (PD) or laparoscopic Heller’s myotomy combined with an anti-reflux procedure. The study aim was to compare laparoscopic Heller cardiomyotomy plus Dor’s fundoplication (LHCM) with PD for the treatment of achalasia.
Patients and methods
In this interventional study, we included 50 adult patients diagnosed as having achalasia by performing either a barium study or by the absence of peristalsis and impaired relaxation of the lower esophageal sphincter on esophageal manometry. The patients were randomly classified into two groups according to the intervention performed: PD or LHCM. Follow-up evaluations were performed after 8 and 16 months.
Results
In total, 50 patients with achalasia and an Eckardt symptom score more than 3 were managed by two different interventions according to their groups. After 16 months of follow-up, the height of a barium-contrast column after 5 min was significantly lower in the LHCM group than in the PD group. There were no other statistically significant differences in the primary or secondary outcomes between the two groups.
Conclusion
After 16 months of follow-up, the rates of therapeutic success and number of complications were nearly similar between LHCM and PD. We conclude superiority of LHCM due to the better recorded height of barium swallow after 16 months of follow-up.