Esophageal Achalasia: Predictive Value of Preoperative Resting Pressure of LES Correlated with Type of Fundoplication

Abstract

Objective: The aim of the present study is to show the predictive value of the preoperative resting pressure of the lower esophageal sphincter (LES) correlated with the type of fundoplication (Nissen or Dor) after Heller myotomy in our series. Materials and Methods:From January 1998 to June 2010, 88 patients affected by esophageal achalasia underwent surgery at our unit. However, our study focused on a sample of 36 patients, because many data were lost or was never recorded. Among these, 14 patients underwent laparoscopic Heller myotomy plus Nissen fundoplication (group N), whereas 22 patients underwent laparoscopic Heller myotomy plus Dor fundoplication (group D). Clinical evaluation was performed using a modified DeMeester symptom scoring system consisting of the assessment of three symptoms: dysphagia, regurgitation, and heartburn. To each symptom was assigned a score from 0 to 3, depending on its severity, and the reduction in the severity of each symptom after surgery was assessed.Results: The surgical treatment is considered to be effective (p<0.0001). The preoperative resting pressures of LES were compared by Student's t-test, and it was found that patients who reported a greater improvement in the dysphagia symptom had a preoperative average pressure of LES that was significantly higher than that in other patients in both group N (p=0.03) and group D (p=0.01; p=0.003; p=0.001). The Dor treatment was shown to be more effective than the Nissen treatment (p<0.0001). Conclusion:The preoperative resting pressure of LES is a predictive factor of surgical success both before Dor fundoplication and before Nissen fundoplication, but its predictive power is influenced by the chosen type of fundoplication.Keywords: Achalasia, dysphagia, preoperative resting pressure of LES, predictive factors, fundoplication ÖZ Amaç: Bu çalışmanın amacı, serimizdeki Heller miyotomi sonrasında, funduplikasyon türü (Nissen veya Dor) ile ilişkili olarak alt özofageal sfinkterin (AÖS) preoperatif istirahat basıncının prediktif değerini göstermektir.Gereç ve Yöntem: Ocak 1998 ile Haziran 2010 arasında, özofageal akalazyadan etkilenen 88 hasta birimimizde ameliyat oldular. Ancak çalışmamızda, birçok verinin kaybolmasından veya hiç kaydedilmemiş olmasından dolayı, 36 hastaneden oluşan bir örnekleme odaklanıldı. Bu hastalardan 14'üne laparoskopik Heller miyotomi+Nissen fundoplikasyon (N grubu) uygulanırken, 22'sine laparoskopik Heller miyotomi+Dor fundoplikasyon (D grubu) uygulandı. Klinik değerlendirme, disfaji, regürjitasyon ve mide yanması olan üç semptomun değerlendirilmesini içeren modifiye DeMeester semptom skorlama sistemi kullanılarak yapıldı. Her bir semptoma 0 ile 3 arası bir puan verildi ve ameliyat sonrası her semptomun şiddetindeki azalma değerlendirildi.Bulgular: Cerrahi tedavinin etkili olduğu düşünülmektedir (p<0,0001). Ameliyat öncesi AÖS istirahat basınçları Student's t-test ile karşılaştırıldı. Disfaji semptomunda gelişme görülen hastalarda ameliyat öncesi ortalama AÖS basıncı, N grubu (p=0,03) ve D grubundaki (p...