Postoperative Gastroesophageal Reflux After Laparoscopic Heller-Dor for Achalasia: True Incidence with an Objective Evaluation

Renato Salvador, Elisa Pesenti, Laura Gobbi, Giovanni Capovilla, Lorenzo Spadotto, Guerrino Voltarel, Francesco Cavallin, Loredana Nicoletti, Michele Valmasoni, Alberto Ruol, Stefano Merigliano, Mario Costantini

Research output: Contribution to journalArticlepeer-review


Introduction: The most common complication after laparoscopic Heller-Dor (LHD) is gastroesophageal reflux disease (GERD). The present study aimed (a) to analyze the true incidence of postoperative reflux by objectively assessing a large group of LHD patients and (b) to see whether the presence of typical GERD symptoms correlates with the real incidence of postoperative reflux. Methods: After LHD, patients were assessed by means of a symptom score, endoscopy, esophageal manometry, and 24-h pH monitoring. Patients were assigned to three groups: those did not accept to perform 24-h pH monitoring (group NP); those with normal postoperative pH findings (group A); and those with pathological postoperative acid exposure (group B). Results: Four hundred sixty-three of the 806 LHD patients agreed to undergo follow-up 24-h pH monitoring. Normal pH findings were seen in 423 patients (group A, 91.4 %), while 40 (8.6 %) had a pathological acid exposure (group B). The median symptom scores were similar: 3.0 (IQR 0–8) in group A and 6.0 (IQR 0–10) in group B (p = 0.29). At endoscopy, the percentage of esophagitis was also similar (11 % in group A, 19 % in group B; p = 0.28). Conclusions: This study demonstrated that, after LHD was performed by experienced surgeons, the true incidence of postoperative GERD is very low. The incidence of this possible complication should be assessed by pH monitoring because endoscopic findings and symptoms may be misleading.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalJournal of Gastrointestinal Surgery
Publication statusAccepted/In press - Jun 30 2016


  • Achalasia
  • Gastroesophageal reflux
  • GERD
  • Heller myotomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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