Clinical outcomes and quality of life following laparoscopic Heller’s myotomy for achalasia cardia: an observational study from a tertiary care hospital

Background: The clinical outcomes of Achalasia cardia (AC) following Laparoscopic Heller’s myotomy in terms of improvement in clinical symptom scores as well as the quality of life (QOL) have not been investigated extensively in the literature, which has been analyzed in this study. The role of physiological tests after surgery, along with their relationship to symptom evaluation, was evaluated in the present investigation. Methods: 65 patients who had Laparoscopic Heller's myotomy with Dor's fundoplication (LHMD) between August 2014 and July 2022 were included in this retrospective analysis. Eckardt score (ES) calculation, ASHRQOL (Achalasia Specific Health-Related Quality of Life) questionnaire score, measurement of 5-minute column height in TBE (Timed Barium Esophagogram), as well as median IRP (Integrated Relaxation Pressure) in HRM (High-Resolution Manometry) were done. All patients then underwent LHMD. Results: ES (8.18±1.06 to 1.57±1.06, P=0.005), ASHRQOL score (63.10±11.84 to 7.29±6.20, P=0.005), 5-minute column height on TBE (104.86±16.42 mm to 11.43±16.83 mm, P=0.005), along with IRP (25.58±4.35 mm Hg to 3.88±3.15 mm Hg, P=0.005) all demonstrated substantial gains at a median follow-up of 24 months. Eckardt score correlated significantly with ASHRQOL scores (ρ=0.996, P=0.005), TBE height at 5-minute (ρ=0.921, P=0.005), as well as median IRP (ρ=0.866, P=0.005). The improvement in TBE height correlated strongly with median IRP (ρ=0.928, P=0.005). Conclusion: LHMD leads to sustained symptom relief and significant enhancement in QOL. Clinical score improvement correlates among themselves as well as with physiological scores. Therefore, regular follow-up may not require physiological testing by manometry.