The outcome of modified Heller's myotomy for achalasia: A 3-center study in Nigeria

Background: Achalasia is a rare disease. The present standard treatment is laparoscopic Heller's myotomy. Some centers still use thoracoscopy, thoracotomy, or laparotomy. Newer approaches such as the per-oral endoscopic esophagomyotomy are being evaluated. Objectives: The objective of the study was to review the diagnostic procedures for achalasia cardia and the therapeutic approaches being used in the study centers and to evaluate the dysphagia and reflux esophagitis outcomes and the occurrence of operative complications. Methods: This is a retrospective study over 10 years (2008–2017) from three centers in Nigeria. The clinical and operative records were reviewed. The route and outcome of modified Heller's myotomy for achalasia cardia were reviewed. Results: The total number of cases was 16. The male-to-female ratio was 1:1, and age ranged from 3 to 55 years. Diagnosis was done by clinical features and barium swallow test. Two of the 16 cases were done via the laparotomy approach, while the remaining 14 were achieved via a left thoracotomy. Only in one case was fundoplication done. Perioperative mortality was zero. Overall long-term dysphagia and reflux outcomes were satisfactory. Conclusion: Clinical and radiological features are predominantly used to diagnose achalasia; esophageal manometry was not available. Surgery was predominantly done by the thoracotomy approach, with occasional fundoplication.