The management of achalasia in Sudan : Heller’s myotomy versus pneumatic dilatation

Abstract EN

Objective: Heller’s myotomy and pneumatic balloon dilatations (PBD) are the two principal modalities for treatment of achalasia in Sudan.

The choice between the two former modalities as the initial treatment of achalasia is controversial.

The aim of this study is to evaluate the efficacy and outcomes of Heller’s myotomy compared to pneumatic balloon dilatations (PBD) as initial treatment of achalasia.

Methods: This is a descriptive, cross-sectional, non-randomized hospital-based study.

Sixty patients with achalasia were studied from January 2006 to December 2012.

Patients were subdivided according to treatment they received, either by pneumatic balloon dilatation (n=30) or open Heller’s myotomy combined with anti-reflux surgery (n=30).

Patients in both groups were referred directly by physician according to their preference.

Data was collected as regard clinical presentation, management and outcome.

Patients were followed for 2 years.

Results: The mean age was 38.7±14.16 and 41.6±16.6 years, with equal male to female ratio in the surgical and dilatation group respectively.

Dysphagia, regurgitation and weight loss were the most presenting symptoms in all patients.

Symptoms score before treatment was comparable 11.7±2.33 versus 11.2±2.90 for surgery and dilatation group respectively.

Following treatment, dysphagia was completely relieved in 23 (76.7%) of surgical patients compared to 10 (33.3%) of patients who underwent dilatation (p=0.001).

Surgical patients had significant relief of regurgitation (n=28, 93.3%) versus (n=15, 50%) of dilatation group (p=0.02).

Dilatation group showed a significant more rapid response to treatment, earlier return to normal activity and a shorter hospital stay than surgical group.

The overall outcome of treatment was excellent in 76.7% vs.

26.7%, good in 16.7% vs.

33.3% and poor in 6.7 %vs.

40% for surgical and dilatation group respectively, (p=0.000).

Conclusions: Open Heller’s myotomy with fundoplication was more effective, have long durability and better outcome than pneumatic balloon dilatations (PBD) as initial treatment of achalasia.