Comparative study between laparoscopic Heller’s cardiomyotomy and peroral endoscopic myotomy in treatment of esophageal achalasia

Abstract

Background Achalasia is a motility disorder characterized by the lower esophageal sphincter’s inability to relax in absence of peristalsis. It causes dysphagia, undigested food regurgitation, chest pain, weight loss, and respiratory symptoms such as nocturnal cough, recurrent aspiration, and pneumonia. Patients and methods This study included 46 patients who were admitted with symptoms of achalasia in Cairo University hospitals. Laparoscopic Heller’s cardiomyotomy (LHM) was performed for 23 patients and peroral endoscopic myotomy (POEM) was done for other 23 patients. Clinical assessment using the Eckardt score was done for all patients preoperatively and 3 months postoperatively. Results The operative time ranged from 90 to 160 min in LHM patients (group 1) (mean, 125.7 min), whereas it ranged from 75 to 180 min in POEM patients (group 2) (mean, 123.8 min). BMI postoperatively ranged from 25.2 to 30.9 kg/m2 (mean, 26.9 kg/m2) in group 1, whereas in group 2, it ranged from 16.02 to 43.36 kg/m2 (mean, 26.8 kg/m2). Conclusion There was no significant difference between LHM and POEM in terms of their resolution or improvement of symptoms of achalasia in our research, but there was a significant difference regarding gastroesophageal reflux symptoms postoperatively between both groups, in which gastroesophageal reflux symptoms postoperatively occurred with POEM and did not occur with LHM.