Long-term outcomes after treatment of esophageal achalasia: a single-center retrospective study of laparoscopic Heller myotomy with partial fundoplication vs pneumatic dilation
- 1Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
- 2Department of Gastroenterology, Lithuanian University of Health Sciences, Kaunas, Lithuania
Abstract
INTRODUCTION:: Achalasia is a chronic esophageal motility disorder characterized by impaired esophagogastric junction (EGJ) relaxation and absent or ineffective esophageal peristalsis, resulting primarily in dysphagia and impaired esophageal emptying. Established treatments are palliative and aim to reduce outflow resistance at the EGJ.
AIM:: We aimed to evaluate long-term clinical and manometric outcomes after laparoscopic Heller myotomy (LHM) with partial fundoplication or pneumatic dilation (PD) in patients with achalasia treated at a single center, and to compare outcomes of Dor vs Toupet fundoplication.
MATERIALS AND METHODS:: This retrospective, single-center observational study identified 166 patients treated between 1998 and 2019, of whom 132 underwent LHM with Dor or Toupet fundoplication and 34 underwent PD. In 2024, long-term follow-up assessment was completed in 76 patients, including 55 after LHM and 21 after PD. Follow-up assessment included clinical evaluation, upper gastrointestinal endoscopy, and high-resolution manometry. Dysphagia grades 0–I were defined as treatment success and grades II–III as treatment failure.
RESULTS:: Clinical treatment success was observed in 46/55 patients (83.6%) after LHM and in 6/21 individuals (28.6%) after PD (P <0.001). Adequate heartburn control was observed in 33/55 patients (60%) after LHM and in 9/21 (42.9%) after PD (P = 0.21). Residual integrated relaxation pressure (IRP) was lower in the individuals with clinical treatment success than in those with treatment failure after both LHM (P = 0.008) and PD (P <0.001). There were no differences in long-term dysphagia or heartburn control between Dor and Toupet fundoplication.
CONCLUSIONS:: In the patients available for long-term follow-up, LHM with partial fundoplication was associated with a higher rate of sustained dysphagia control than PD. Higher residual IRP was associated with clinical treatment failure, while long-term dysphagia and heartburn outcomes did not differ between Dor and Toupet fundoplication. Because treatment allocation was nonrandomized and long-term follow-up was incomplete, the comparative findings should be interpreted cautiously.
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BibTeX
@article{kiudelis2026longterm,
title = {{Long-term outcomes after treatment of esophageal achalasia: a single-center retrospective study of laparoscopic Heller myotomy with partial fundoplication vs pneumatic dilation}},
author = {Mindaugas Kiudelis and Antanas Mickevičius and Matas Pažusis and Vilius Ripkauskas and Rolandas Gedgaudas and Limas Kupčinskas},
journal = {Videosurgery and other Miniinvasive Techniques},
year = {2026},
month = oct,
doi = {10.20452/wiitm.2026.18050},
url = {https://doi.org/10.20452/wiitm.2026.18050},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - Long-term outcomes after treatment of esophageal achalasia: a single-center retrospective study of laparoscopic Heller myotomy with partial fundoplication vs pneumatic dilation
AU - Mindaugas Kiudelis
AU - Antanas Mickevičius
AU - Matas Pažusis
AU - Vilius Ripkauskas
AU - Rolandas Gedgaudas
AU - Limas Kupčinskas
PY - 2026
DA - 2026/10/14
JO - Videosurgery and other Miniinvasive Techniques
DO - 10.20452/wiitm.2026.18050
UR - https://doi.org/10.20452/wiitm.2026.18050
AB - INTRODUCTION:: Achalasia is a chronic esophageal motility disorder characterized by impaired esophagogastric junction (EGJ) relaxation and absent or ineffective esophageal peristalsis, resulting primarily in dysphagia and impaired esophageal emptying. Established treatments are palliative and aim to reduce outflow resistance at the EGJ. AIM:: We aimed to evaluate long-term clinical and manometric outcomes after laparoscopic Heller myotomy (LHM) with partial fundoplication or pneumatic dilation (PD) in patients with achalasia treated at a single center, and to compare outcomes of Dor vs Toupet fundoplication. MATERIALS AND METHODS:: This retrospective, single-center observational study identified 166 patients treated between 1998 and 2019, of whom 132 underwent LHM with Dor or Toupet fundoplication and 34 underwent PD. In 2024, long-term follow-up assessment was completed in 76 patients, including 55 after LHM and 21 after PD. Follow-up assessment included clinical evaluation, upper gastrointestinal endoscopy, and high-resolution manometry. Dysphagia grades 0–I were defined as treatment success and grades II–III as treatment failure. RESULTS:: Clinical treatment success was observed in 46/55 patients (83.6%) after LHM and in 6/21 individuals (28.6%) after PD (P <0.001). Adequate heartburn control was observed in 33/55 patients (60%) after LHM and in 9/21 (42.9%) after PD (P = 0.21). Residual integrated relaxation pressure (IRP) was lower in the individuals with clinical treatment success than in those with treatment failure after both LHM (P = 0.008) and PD (P <0.001). There were no differences in long-term dysphagia or heartburn control between Dor and Toupet fundoplication. CONCLUSIONS:: In the patients available for long-term follow-up, LHM with partial fundoplication was associated with a higher rate of sustained dysphagia control than PD. Higher residual IRP was associated with clinical treatment failure, while long-term dysphagia and heartburn outcomes did not differ between Dor and Toupet fundoplication. Because treatment allocation was nonrandomized and long-term follow-up was incomplete, the comparative findings should be interpreted cautiously.
SN - 1895-4588
SN - 2299-0054
ER -