Post operative manometric patterns of antireflux fundoplication in patients followed-up after Heller-Dor operation for esophageal achalasia

Aims of the study Nowadays the Heller-Dor procedure is one of the techniques most frequently adopted for the surgical therapy of esophageal achalasia. Aim of this study is to verify if post operative manometric values of length and pressure of the fundoplication may predict the long-term clinical result of the Heller-Dor . Materials and methods Over174 patients operated upon in 66 (24 men, mean age 53.9 yrs. ±17 r. 18-88, Median F.U. 120 mths) in the period 1978-2002, post-operative (>12 mths) values of length and pressure of the Dor fundoplication were recorded and related to long-term results evaluated as follow: excellent = symptoms free; Good = occasional dysphagia or pain and hearthburn less than once a week and free from esophagitis; Fair = dysphagia once or more a week and postural and spontaneous heartburn up to a maximum of four times a day with occasional acid regurgitation and microscopic esophagitis; Poor = Daily dysphagia with regurgitation and weight loss, daily reflux symtoms and severe esophagitis. Summary of the results Manometrc findings are shown in table. Follow-up Pressure (mmHg) Length (cm) Mean SD Mean SD Excellent 14.3 2.9 4.5 0.3 Good 9.2 0.6 4.4 0.3 Fair 8 0.1 4.3 0.2 Poor 5.9 2.1 4 0.5 Follow-up Pressure p < 0.001 Follow-up Length p = 0.004 Comment Post-operative manometric values are useful to predict patient’s outcome and then to plan the follow-up.