Long-term outcomes of Heller myotomy for achalasia: 5-year access comparison

Achalasia cardia (AC) is associated with marked impairment of oesophageal food transit and a substantial reduction in quality of life. Despite the widespread use of Heller myotomy, the effect of the type of surgical access on long-term treatment outcomes remains poorly understood. The purpose was to evaluate and compare the five-year results of the Heller myotomy performed by laparoscopic and open access with the analysis of clinical, functional, radiological, and endoscopic parameters. A combined retrospective and prospective multicentre study was conducted, which included 38 patients with confirmed AC. Surgical procedures were performed using open and laparoscopic approaches with antireflux correction. The assessment of efficacy was based on clinical symptoms, radiographic and endoscopic findings, and changes in the symptom severity score. The follow-up period was up to five years. After surgical treatment, there was a statistically significant improvement in all the parameters under study. The severity of symptoms decreased from 8.8 ± 1.5 to 1.7 ± 0.8, the frequency of dysphagia decreased from 100% to 7.9%, and regurgitation decreased from 83.3% to 5.6%. X-ray examination revealed a decrease in the diameter of the oesophagus from 4.8 ± 0.7 to 3.2 ± 0.5 cm and an almost complete elimination of contrast delay. Endoscopic findings confirmed the restoration of cardia patency and a reduction in inflammatory changes of the mucosa. Laparoscopic access demonstrated a more pronounced recovery of evacuation function and a lower incidence of residual disorders compared with open interventions. The results obtained confirmed the high efficiency of Heller myotomy and substantiated the advantage of laparoscopic access in the treatment of AC. The data can be used to optimise surgical tactics and improve the quality of patient treatment, and serve as a basis for further research with sample expansion and standardisation of evaluation criteria