# Laparoscopic Heller myotomy with Dor fundoplication for achalasia: an outcome in a tertiary health center of Nepal

## TL;DR

This study shows that a specific surgical procedure for achalasia provides long-term symptom relief with minimal complications in a Nepalese hospital.

## Contribution

The study presents long-term outcomes of Laparoscopic Heller Myotomy with Dor fundoplication in a Nepalese tertiary center.

## Key findings

- Eckardt scores improved significantly from preoperative to 3 months and long-term follow-up.
- Only two treatment failures occurred, with minimal reflux complications observed.
- Median long-term follow-up showed sustained symptom relief over 32 months.

## Abstract

Laparoscopic Heller Myotomy with Dor fundoplication is the most effective therapeutic option for Achalasia cardia, with fewer complications. We present the outcomes of this procedure with long-term follow-up in patients with Achalasia cardia.

A single institution prospectively maintained data of Laparoscopic Heller Myotomy with Dor fundoplication between January 2014 and January 2024 was reviewed. Eckardt scores at three-time points (preoperative, 3-month, and long-term follow-up) were used to assess treatment efficacy.

A total of 16 patients had a median age of 34 years. Megaesophagus was observed in 8 (50%) patients, and 5 patients had sigmoid esophagus. The mean operative time was 162 ± 41 min. The mean myotomy length was 6.1 cm and 2.19 cm, respectively, for the esophagus and the stomach. Following the surgery, there was significant improvement in the Eckardt score from a median preoperative score of 9 (5–12) to a median postoperative score of 2(0–4) in 3 months (p = 0.001) and a median Eckardt score of 1.5 (0–3) in long-term follow-up (P < 0.001). The median long-term follow-up was 32 months (12–60 months). Overall, two treatment failure was observed, and one required endoscopic balloon dilatation. The gastroesophageal reflux (uncomplicated) was observed in 5 (31.2%) patients. The symptoms were mild, and none had reflux-related complications at the last follow-up.

LHM provides immediate and durable symptomatic relief with fewer complications.