Beyond symptom relief: Linking anatomy, physiology and quality of life after laparoscopic Heller myotomy with Dor fundoplication

INTRODUCTION: Laparoscopic Heller myotomy (LHM), usually combined with fundoplication, is an established treatment for achalasia cardia (AC). This study evaluated the anatomical and physiological outcomes of LHM and their association with quality of life (QoL). PATIENTS AND METHODS: This ambispective observational study included patients undergoing LHM with Dor fundoplication. The ambispective design comprised retrospective extraction of perioperative and follow-up data from institutional records and a prospectively maintained database, with patient-reported outcomes collected at follow-up visits and, when in-person review was not feasible, through telephone interviews. Anatomical changes were assessed by imaging. Physiological parameters, including lower oesophageal sphincter function and oesophageal emptying, were evaluated using high-resolution manometry and timed barium oesophagography. QoL was assessed preoperatively and postoperatively using the Eckardt score (ES) and the Achalasia-dysphagia QoL (A-DsQoL) questionnaire. RESULTS: Mean oesophageal diameter decreased from 32.57 mm to 20.76 mm, with a reduction of 11.81 mm (standard deviation [SD]: 5.78; P < 0.001). Mean integrated relaxation pressure (IRP) declined from 27.29 mmHg (SD: 6.77) to 15.05 mmHg (SD: 4.19), with a reduction of 12.24 mmHg (SD: 5.19; P < 0.001). Mean ES improved from 6.05 (SD: 1.50) to 0.86 (SD: 0.85) at 1 year (P < 0.001) and mean A-DsQoL score improved from 25.86 (SD: 2.76) to 9.43 (SD: 1.33) (P < 0.001). Changes in ES showed weak, non-significant correlations with IRP change and oesophageal diameter change. CONCLUSION: LHM with Dor fundoplication is a safe and effective treatment for AC, improving symptoms and QoL. Symptom improvement does not consistently parallel anatomical or physiological changes, highlighting the need for assessment.