Background

Despite a high degree of satisfaction with laparoscopic Heller–Dor surgery (LHD) for esophageal achalasia, some cases show no improvement in postoperative esophageal clearance. We investigated whether an objective evaluation is essential for determining the therapeutic effect of LHD.

Methods

We investigated the difference in symptoms, regarding esophageal clearance, using timed barium esophagogram (TBE), in 306 esophageal achalasia patients with high postoperative satisfaction who underwent LHD. Furthermore, these patients were divided into two groups, in accordance with the difference in postoperative esophageal clearance, in order to compare the preoperative pathophysiology, symptoms, and surgical results.

Results

Although the poor postoperative esophageal clearance group (117 cases, 38%) was mostly male and the ratio of Sigmoid type was high compared to the good postoperative esophageal clearance group (p = 0.046, p = 0.001, respectively); in patients with high surgical satisfaction, there was no difference in terms of preoperative symptom scores and surgical results. However, although the satisfaction level was high in the poor esophageal clearance group, the scores in terms of the postoperative dysphagia and vomiting were high (p = 0.0018 and p = 0.004, respectively). The AUC was 0.9842 upon ROC analysis regarding the presence or absence of clearance at 2 min following postoperative TBE and the postoperative feeling of difficulty swallowing score, with a cut-off value of 2 points (sensitivity: 88%, specificity: 100%) in cases with a high degree of surgical satisfaction.

Conclusion

The esophageal clearance ability can be predicted by subjective evaluation, based on the postoperative symptom scores; so, an objective evaluation is not essential in cases with high surgical satisfaction.

中文翻译：

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客观评价对于确定食管贲门失弛缓症患者腹腔镜手术的治疗效果是否必不可少？

背景

尽管对食管贲门失弛缓症腹腔镜 Heller-Dor 手术 (LHD) 的满意度很高，但一些病例显示术后食管清除率没有改善。我们调查了客观评估对于确定 LHD 的治疗效果是否必不可少。

方法

我们使用定时食管钡剂造影 (TBE) 调查了 306 名接受 LHD 术后满意度高的食管贲门失弛缓症患者在食管清除方面的症状差异。此外，根据术后食管间隙的差异将这些患者分为两组，以比较术前的病理生理、症状和手术结果。

结果

尽管术后食管清除不良组（117 例，38%）男性居多且乙状结肠型的比例高于术后食管清除良好组（分别为p  = 0.046、p  = 0.001）；在手术满意度高的患者中，术前症状评分和手术结果没有差异。然而，尽管食管清除不良组的满意度较高，但术后吞咽困难和呕吐方面的评分较高（p  = 0.0018 和p = 0.004，分别）。关于术后 TBE 后 2 分钟是否存在清除和术后吞咽困难感评分的 ROC 分析，AUC 为 0.9842，截止值为 2 分（敏感性：88%，特异性：100%）手术满意度高的病例。

结论

根据术后症状评分，可以通过主观评价预测食管清除能力；因此，在手术满意度高的情况下，客观评估不是必需的。