Laparoscopic Heller myotomy versus peroral endoscopic myotomy for achalasia: safety, efficacy and complications

Abstract

Objective To compare the clinical efficacy of laparoscopic Heller myotomy (LHM) and peroral endoscopic myotomy (POEM) for treatment of achalasia, and investigate the strategy for management of gastroesophageal reflux disease (GERD) after POEM. Methods This retrospective cohort study was conducted among 61 patients undergoing minimally invasive surgery for achalasia in our hospital between October, 2012 and April, 2017. Of the 61 patients, 30 underwent LHM with Dor fundoplication (LHM group) and 31 underwent POEM. All patients were followed up to April, 2019. The general and perioperative data, clinical efficacy, and incidence of GERD complications (including GERD symptoms, pathological acid reflux and esophagitis) were compared between the 2 groups. Results The operations were completed smoothly in all the patients without perioperative death. There were no significant differences between LHM and POEM groups in the operation time, intraoperative blood loss, perioperative complications, mean hospital stay or hospital costs. The 2 operations produced similar therapeutic effective rate [86.7% (26/30) vs 90.3%(28/31), P>0.05], and the Ecardt score and the lower esophageal sphincter pressure were decreased significantly in both groups after the operation (P < 0.001), but there were no difference between the 2 operations. Compared with LHM, POEM was associated with significantly higher incidences of GERD symptoms (3/27 vs 11/20, P=0.018), pathological acid reflux (4/26 vs 12/18, P=0.024), and esophagitis (2/28 vs 9/22, P=0.023); the incidence of clinically relevant GERD was much higher in POEM group than in LHM group (1/29 vs 7/24, P=0.026). Conclusion LHM and POEM have similar safety and mid- and long-term efficacies for treatment of achalasia, but the absence of an antireflux wrap in POEM surgery leads to an increased risk of GERD. Patients planning to undergo POEM surgery should be closely followed after the surgery and given timely implementation of active interventions.

Keywords

• achalasia
• laparoscopic heller myotomy
• peroral endoscopic myotomy
• gastroesophageal reflux disease