Laparoscopic heller esophagomyotomy is safe and effective in rural East Africa

Abstract

Background: The incidence of achalasia in sub- Saharan Africa is not known. Experience in our region suggests the disorder affects mainly younger patients. Esophagomyotomy is the gold standard treatment for achalasia. Benefits of laparoscopic treatment are well documented in western populations. African data is
insufficient.

Methods: A retrospective review of patients over 16 years who underwent esophagomyotomy at Tenwek Hospital (2008–2017). The primary outcome was improvement in symptoms before and after surgery as measured using the Eckardt score— lower scores for dysphagia, regurgitation, pain, weight loss indicate less severe symptoms. The secondary outcomes were duration of surgery, length of myotomy, length of hospital stay, and complication rate. Data analysis used ANOVA.

Results: 54 patients were included: 28 with laparoscopic Heller myotomy (LHM), 26 with open Heller myotomy (OHM). LHM patients were younger than OHM patients (p<0.05). Patients who had LHM had lower postoperative Eckardt scores (p<0.05). Duration of surgery for LHM was longer (p<0.001) than for OHM, conversion rate was 10.71%, and length of the myotomy was unaltered. No difference was seen in hospital stay or complication rate between the two groups.

Conclusion: LHM is effective and safe in a rural East African setting, with excellent functional outcomes compared with open techniques. Thus, laparoscopy can be feasible worldwide.

Keywords: Laparoscopic, Heller Esophagomyotomy, Tenwek Hospital, Achalasia