Effects of the preoperative IRP values on the pathophysiology of patients with esophageal achalasia and on the treatment outcome of laparoscopic Heller-Dor surgery

• Published in: Langenbeck's archives of surgery Vol. 406; no. 4; pp. 1037 - 1044
• Main Authors: Tsuboi, Kazuto, Yano, Fumiaki, Omura, Nobuo, Hoshino, Masato, Yamamoto, Se-Ryung, Akimoto, Shunsuke, Masuda, Takahiro, Sakashita, Yuki, Fukushima, Naoko, Ikegami, Toru
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2021
• Subjects: Abdominal Surgery; Cardiac Surgery; General Surgery; Medicine; Medicine & Public Health; Original Article; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Esophageal achalasia; Pathophysiology; Surgical outcome; High-resolution manometry; Integrated relaxation pressure
• ISSN: 1435-2443; 1435-2451
• DOI: 10.1007/s00423-021-02130-y

Purpose One diagnostic criterion of esophageal achalasia is that the integrated relaxation pressure (IRP) measured by high-resolution manometry (HRM) is at least 15 mmHg. Moreover, while the standard surgical treatment for esophageal achalasia is laparoscopic Heller-Dor surgery (LHD), there have been insufficient investigations concerning the surgical outcomes from the perspective of the preoperative IRP value. Methods We split 121 cases in which LHD was performed as an initial treatment on patients with esophageal achalasia, into two categories according to the IRP median value, and performed a comparative investigation of the surgical outcomes with regard to the preoperative pathophysiology and symptoms. Results The IRP median value was 29.6 mmHg. The high IRP group consisted of younger individuals and low BMI ( p = 0.004 and p = 0.0273, respectively), and the percentage of Chicago classification Type II and III was high ( p = 0.029) and the regurgitation score in the preoperative symptoms was high ( p = 0.0043). However, no differences in the surgical outcomes were confirmed. Conclusion In patients with esophageal achalasia, the degree of the preoperative IRP value affects the age, BMI, preoperative LESP, and preoperative regurgitation symptoms. However, there were no effects on the surgical outcomes, with the surgical outcomes being satisfactory, regardless of the IRP value.