Role of Preoperative Oesophgealmanometry in Operative Decision Making in Patients With Cardiac Achalasia

Abstract

Background: Surgery is considered the treatment of choice for esophageal achalasia, since it provides symptomatic relief that is stronger and longer lasting. Laparoscopic Heller cardiomyotomy is the preferred treatment for an anti reflux surgery with found oplication. Preoperative HRM is essential to the detection of sufficient fundoplication. Aim of the work: To assess the role of preoperative manometry in selection the type of antireflux surgery with Heller cardiomyotomy (Dor or Nissen fundoplication). Patients and methods: This prospective cohort study was conducted on twenty (20) patients presented to Ain-Shams University hospitals outpatient clinics suffering from chronic dysphagia from January 2018 through January 2020 to assess the role of preoperative manometry in selection of operative type and decision making in treatment of achalasia. Results: Using HRM ,14 patients (70%) with type 1 achalasia underwent Dor fundoplication and in these Dysphagia and regurgitation improved substantially in patients (p value = 0.001 and 0.001 respectively), also there were 4 patients (28.5%) with post-operative reflux. 6 Patients (30%) with type 2 achalasia underwent Nissen fundoplication and in these patients there was a significant improvement in dysphagia and regurgitation (p value = 0.034 and 0.023 respectively), 3 patients (50%) developed post-operative dysphagia, two of them improved on follow up. There was a significant reduction in LES pressure in both Dor and Nissen operation (p value = 0.001 and 0.026 respectively). Conclusion: Preoperative HRM is crucial in choosing type of fundoplication in achalasia as symptomatic responses vary depending on achalasia subtype.