Long‑term outcomes after treatment of esophageal achalasia: a single‑center retrospective study of laparoscopic Heller myotomy with partial fundoplication vs pneumatic dilation
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction Achalasia is a chronic esophageal motility disorder characterized by impaired esophagogastric junction relaxation and absent or ineffective esophageal peristalsis, resulting primarily in dysphagia and impaired esophageal emptying.Established treatments are palliative and aim to reduce outflow resistance at the esophagogastric junction.Aim To evaluate long-term clinical and manometric outcomes after LHM with partial fundoplication and PD in patients with achalasia treated at a single center and to compare outcomes between Dor and Toupet fundoplication. Materials and methods Thisretrospective single-center observational study identified 166 patients treated between 1998 and 2019: 132 underwent LHM with Dor or Toupet fundoplication and 34 underwent PD.In 2024, long-term follow-up assessment was completed in 76 patients, including 55 after LHM and 21 after PD.Follow-up assessment included clinical evaluation, upper gastrointestinal endoscopy, and HRM.Dysphagia grades 0-I were defined as treatment success and grades II-III as treatment failure.Results Clinical treatment success was observed in 46 of 55 patients (83.6%) after LHM and in 6 of 21 patients (28.6%) after PD (p<0.001).Adequate heartburn control was observed in 33 of 55 patients (60.0%) after LHM and in 9 of 21 patients (42.9%) after PD (p=0.205).Residual integrated relaxation pressure (IRP) was lower among patients with clinical treatment success than among those with treatment failure after both LHM (p=0.008)and PD (p<0.001).There were no differences in long-term dysphagia or heartburn control between Dor and Toupet fundoplication.Conclusions Among patients available for long-term follow-up, LHM with partial fundoplication was associated with a higher observed rate of sustained dysphagia control than PD.Higher residual IRP was associated with clinical treatment failure, while long-term dysphagia and heartburn outcomes did not differ between Dor and Toupet fundoplication.Because treatment allocation was non-randomized and long-term follow-up was incomplete, the comparative findings should be interpreted cautiously.
Institution: Lithuanian University of Health Sciences
Language: English
Subfield: Gastroenterology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,480
OpenAlex ID: W7223203018