Abstract

Background

Achalasia is a rare esophageal motility disorder that affects 1 in 100,000 individuals. Currently, laparoscopic Heller myotomy with anterior fundoplication is the ‘gold standard’ therapy for achalasia, alleviating symptoms by de-functionalizing the lower esophageal sphincter mechanism. The advent of the Laparo-Endoscopic Single Site (LESS) technique provides a more minimally invasive approach to Heller myotomy.

Methods

With IRB approval, 179 patients who underwent LESS Heller myotomy with anterior fundoplication since 2007 have been prospectively followed. Patients self-assessed symptom frequency and severity preoperatively and postoperatively using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Patients scored their scar satisfaction (1 = revolting to 10 = beautiful). Data are presented as median (mean ± SD). Significance was accepted with 95% probability.

Results

Fifty-one percent of patients were men, of age 55 (53 ± 17) years and BMI of 25 (25 ± 6.1) kg/m². Patients had an operative time of 134 (135 ± 34.3) minutes with an estimated blood loss (EBL) of 50 mL. Postoperative complications occurred in 18% of patients (e.g., urinary retention, capnothorax). Length of stay was 1 (2 ± 2.1) day. Preoperatively, symptoms (e.g., dysphagia, regurgitation) were frequent and severe; following myotomy, all symptoms queried were significantly less frequent and severe with follow-up of 28 (34 ± 18.4) months (p < 0.0001 for all, paired Student’s t test). Eighty-seven percent of patients reported they were ‘very satisfied’ or ‘satisfied’ with their experience and 95% of patients would undergo the operation again knowing what they know now. Patients scored their satisfaction with their scar as 10 (9 ± 1.6).

Conclusion

Heller myotomy with anterior fundoplication undertaken via the LESS approach provides efficacious, satisfactory, and durable amelioration of symptoms. Patients reported significant symptom resolution as well as satisfaction with their overall experience. Our decade of experience documenting the salutary benefits of LESS Heller myotomy should be more than enough to encourage surgeons to incorporate the approach into their armamentarium.

中文翻译：

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事半功倍：我们十年的腹腔镜单点 Heller 肌切开术经验支持其应用

摘要

背景

贲门失弛缓症是一种罕见的食管动力障碍，每 100,000 人中就有 1 人患病。目前，腹腔镜 Heller 肌切开术和前胃底折叠术是治疗贲门失弛缓症的“金标准”，通过使下食管括约肌机制失去功能来缓解症状。腹腔镜单点 (LESS) 技术的出现为 Heller 肌切开术提供了一种侵入性更小的方法。

方法

经 IRB 批准，对自 2007 年以来接受前胃底折叠术的 LESS Heller 肌切开术的 179 名患者进行了前瞻性随访。患者在术前和术后使用李克特量表自我评估症状频率和严重程度（0 = 从不/不麻烦到 10 = 总是/非常麻烦）。患者对疤痕满意度进行评分（1 = 反感，10 = 美丽）。数据显示为中位数（平均值±标准差）。显着性以 95% 的概率被接受。

结果

51% 的患者为男性，年龄 55 (53 ± 17) 岁，BMI 为 25 (25 ± 6.1) kg/m ²。患者的手术时间为 134 (135 ± 34.3) 分钟，估计失血量 (EBL) 为 50 mL。18% 的患者出现术后并发症（如尿潴留、二氧化碳胸）。住院时间为 1 (2 ± 2.1) 天。术前，症状（如吞咽困难、反流）频繁且严重；肌切开术后，所有询问的症状发生频率和严重程度显着降低，随访时间为 28 (34 ± 18.4) 个月（所有p  < 0.0001，成对学生t测试）。87% 的患者表示他们对他们的经历“非常满意”或“满意”，并且 95% 的患者会在知道他们现在所知道的情况下再次接受手术。患者对疤痕的满意度为 10 (9 ± 1.6)。

结论

通过 LESS 方法进行的 Heller 肌切开术和前部胃底折叠术提供了有效、令人满意和持久的症状改善。患者报告了显着的症状解决以及对整体体验的满意度。我们十年的经验记录了 LESS Heller 肌切开术的有益益处，应该足以鼓励外科医生将该方法纳入他们的医疗设备。