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



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.


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.


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.


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.

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Study conception and design-Tsuboi, Yano, Omura. Acquisition of data-Tsuboi, Yano, Omura, Hoshino, Yamamoto, Akimoto, Masuda, Sakashita, Fukushima. Analysis and interpretation of data-Tsuboi, Yano, Omura. Drafting of manuscript-Tsuboi, Omura. Critical revision of manuscript-Tsuboi, Omura, Ikegami

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Correspondence to Kazuto Tsuboi.

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Tsuboi, K., Yano, F., Omura, N. et al. Effects of the preoperative IRP values on the pathophysiology of patients with esophageal achalasia and on the treatment outcome of laparoscopic Heller-Dor surgery. Langenbecks Arch Surg (2021). https://doi.org/10.1007/s00423-021-02130-y

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  • Esophageal achalasia
  • High-resolution manometry
  • Integrated relaxation pressure
  • Pathophysiology
  • Surgical outcome