Achalasia and obesity: patient outcomes and impressions following laparoscopic Heller myotomy and Dor fundoplication

Abstract

Purpose

The optimal management of achalasia in obese patients is unclear. For those who have undergone Heller myotomy and fundoplication, the long-term outcomes and their impressions following surgery are largely unknown.

Methods

A retrospective review of patients who underwent laparoscopic Heller myotomy and Dor fundoplication (LHMDF) for achalasia was performed. From this cohort, Class 2 and 3 obese (BMI > 35 kg/m2) patients were identified for short- and long-term outcome analysis.

Results

Between 2003 and 2015, 252 patients underwent LHMDF for achalasia, and 17 (7%) patients had BMI > 35 kg/m2. Pre-operative Eckardt scores varied from 2 to 9, and at short-term (2–4 week) follow-up, scores were 0 or 1. Ten (58%) patients had available long-term (2–144 months) follow-up data. Eckardt scores at this time ranged from 0 to 6. Symptom recurrence was worse for patients with BMI > 40 kg/m2 compared to patients with BMI < 40 kg/m2. BMI was largely unchanged at long-term follow-up regardless of pre-intervention BMI. Most patients were satisfied with surgery but would have considered a combined LHMDF and weight-loss procedure had it been offered.

Conclusion

LHMDF for achalasia in obese patients is safe and effective in the short term. At long-term follow-up, many patients had symptom recurrence and experienced minimal weight loss. Discussing weight-loss surgery at the time LHMDF may be appropriate to ensure long-term achalasia symptom relief.

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Data availability

All data was collected by three individuals and is stored in a privately maintained and de-identified patient database.

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Affiliations

Authors

Contributions

All the authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Jon Harrison, MD; Stephanie Rakestraw, MD; and Stephen Doane, MD. The first draft of the manuscript was written by Jon Harrison, MD, and all the authors commented on previous versions of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Jon M. Harrison.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) of Thomas Jefferson University Hospital approved this study.

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All contacted patients were read an IRB-approved patient rights statement ensuring informed consent.

Verbal informed consent was obtained prior to interview.

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R script used to generate graphics and for statistical analysis can be provided upon request.

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Harrison, J.M., Rakestraw, S.L., Doane, S.M. et al. Achalasia and obesity: patient outcomes and impressions following laparoscopic Heller myotomy and Dor fundoplication. Langenbecks Arch Surg (2020). https://doi.org/10.1007/s00423-020-01912-0

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Keywords

  • Achalasia
  • Obesity
  • Laparoscopic Heller myotomy
  • Bariatric surgery
  • Short- and long-term outcomes