RESUMO
Evidence of long-term outcome of laparoscopic Heller-Dor surgery is limited. The aim of this study was to assess the long-term outcome of achalasia patients after surgery, particularly in relation to the preoperative stage of the disease. Sixty eight patient with esophageal achalasia, undergoing laparoscopic Heller-Dor surgery were assessed clinically and by esophageal radiology, manometry and 24-hour ambulatory pH monitoring before and at 3 months, 1 year, 1 to 3 years, 3 to 5 years and more than 5 years after surgery. The study included 68 patients, 36 were males [52.9%] and 32 were female [47.1%] with median age of 41 years [range 19-79y]. At 1 year after surgery the symptom score was significantly lower than the preoperative score [p<0.001], and a satisfactory clinical outcome was seen in more than 90% of the patients with stage I, II and III disease at the preoperative radiologic assessment Only 50% of stage IV patients reported satisfactory results. An adequate opening of the lower esophageal sphincter [LES] and LES resting pressure of less than 8mm Hg was achieved in all patients and esophageal emptying was accelerated significantly [p<0.001]. At the consecutive follow-up evaluation [1-5y], the satisfactory outcome was maintained in all stage I, II and III responders. Those with initially unsatisfactory results [stage IV patients] reported a worsening of symptoms [p<0.02]. LES opening and resting pressure remained at the level of the 1-y follow-up evaluation. Esophageal emptying remained satisfactory in stage I, II and III responders, but deteriorated in stage IV non-responders. A satisfactory outcome has been achieved after laparoscopic Heller-Dor procedure in stage I, II and III achalasic patients and seems to last. Stage IV nonresporders tend to deteriorate over time