Long-term results of laparoscopic Heller-Dor for esophageal-gastric junction outflow obstruction: a prospective comparative study.

IF 12.5 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2025-02-01 DOI:10.1097/JS9.0000000000002170

Renato Salvador, Francesca Forattini, Luca Provenzano, Andrea Costantini, Arianna Vittori, Matteo Santangelo, Giovanni Capovilla, Mario Costantini, Lucia Moletta, Giulia Nezi, Loredana Nicoletti, Michele Valmasoni

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引用次数: 0

Abstract

Background: The aim of this prospective, controlled study was to assess the 5-year follow-up of laparoscopic Heller-Dor (LHD) in patients with esophago-gastric junction outflow obstruction (EGJOO), compared with achalasia patients (ACH). The management of EGJOO reflects the experience gained with esophageal achalasia, for which LHD has been proven to be an effective long-term treatment. Prospective long-term results of LHD in EGJOO patients are still lacking.

Materials and methods: Patients with diagnosis of idiopathic EGJOO referred for dysphagia or food-regurgitation, treated with LHD, were enrolled and then followed prospectively for 5 years. During the follow-up, patients were evaluated with Eckardt score (ES), Barium-swallow X-ray, high-resolution manometry (HRM), 24-hour pH-monitoring and endoscopy. Primary outcome was therapeutic success (ES ≤ 3 or no additional treatment).

Results: The study involved 150 patients: 25 in the EGJOO group and 125 in the ACH group. After 5 years, there was no significant difference in success rate: 90.5% in the EGJOO group, 87.5% in ACH stage I - pattern I, 91.6% in ACH stage I - pattern II and pattern III ( P = 0.94). The ES and all the HRM parameters were similar in all groups. Moreover, the screening endoscopy and the 24-hour pH-monitoring showed a similar postoperative acid exposure in all groups.

Conclusion: This is the first study based on prospective data to assess the long-term outcome of LHD in patients with EGJOO. After at least 5 years of follow-up, LHD has a comparable success rate in both EGJOO and achalasia patients and can be proposed as a safe and effective treatment for EGJOO patients.

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腹腔镜Heller-Dor治疗食管胃交界流出梗阻的远期疗效：一项前瞻性比较研究。

背景：本前瞻性对照研究的目的是评估腹腔镜Heller-Dor （LHD）对食管胃交界流出梗阻（EGJOO）患者的5年随访，并与贲门失弛缓症（ACH）患者进行比较。EGJOO的管理反映了食管贲门失弛缓症的经验，LHD已被证明是一种有效的长期治疗方法。EGJOO患者LHD的远期预后仍缺乏。材料和方法：入选以吞咽困难或食物反流为诊断的特发性EGJOO患者，并接受LHD治疗，前瞻性随访5年。随访期间，对患者进行Eckard评分（ES）、吞钡x线、高分辨率测压（HRM）、24小时ph监测和内窥镜检查。主要结局为治疗成功（ES≤3或无额外治疗）。结果：本研究共纳入150例患者，EGJOO组25例，ACH组125例。5年后，两组患者的成功率差异无统计学意义：EGJOO组为90.5%，ACH I型I期为87.5%，ACH I型II和III期为91.6% （p = 0.94）。ES和所有HRM参数在所有组中相似。此外，筛查内窥镜和24小时ph监测显示，所有组的术后酸暴露相似。结论：这是首个基于前瞻性数据评估EGJOO患者LHD长期预后的研究。经过至少5年的随访，LHD在EGJOO和贲门失弛缓症患者中具有相当的成功率，可以作为EGJOO患者安全有效的治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.