The Heller-Dor operation for the therapy of oesophageal achalasia 1979-2009. History, Rationale, technique and definitive results.

Background/Objectives: to show step by step the technical details of the Heller-Dor operation in light of the evolution of surgery for the cure of oesophageal achalasia occurred in 30 years in a surgical group. Materials & Methods: The current technique is based on two corner stone principles originated from two groups of patients operated upon in the sixties and seventies respectively with the trans abdominal and the trans thoracic myotomy. In order to avoid post operative reflux (41%) and dysphagia (8%) due to scar of the myotomy (abdominal myotomy without antireflux procedure) and the relapse of dysphagia (21%) due to insufficient myotomy (limited thoracic myotomy), we pursued: 1) the complete abolition of the lower esophageal sphincter by a long myotomy extended to the U and sling fibers below the angle of His which are part of the lower oesophageal sphincter (LOS) (according to Dr. Liebermann-Meffert), 2) protection of the surface of the myotomy with an anterior fundusplication to prevent reflux without impairing oesophageal emptying. The operation was performed under manometric control. Results: In the period 1978-2009 262 patients were operated upon, 202 with open (median FU 96 months r. 12-324), and 60 with laparoscopic technique (median FU 48 months r. 6-161). In laparotomy poor results (19/201 9.5%) were secondary to reflux oesophagitis in 15/201 (7.5%), in 2 cases diagnosed after 184 and 252 months, and to recurrent dysphagia in 4/201 (2%) all with end stage sigmoid achalasia. In laparoscopy 2/60 (3.3%) had reflux oesophagitis and none recurrent dysphagia. Conclusions/Uploads: A long esophago-gastric myotomy protected by the Dor fundusplication offers good long term results. Disclosure: All authors have declared no conflicts of interest.