Objective To compare effectiveness between laparoscopic Heller myotomy and peroral endoscopic myotomy (POEM) in treatment of achalasia of cardia (AC) in order to provide a basis for clinical choose. Method The literatures about the treatment of AC by laparoscopic Heller myotomy or POEM were retrieved from CNKI, Embase, PubMed databases, etc., and then the contents about curative effect and complications were summarized. Results The treatment models of AC included surgical treatment such as laparoscopic Heller myotomy and endoscopy such as POEM, but there was still lack of comparing data in these two treatment models, its selection remained controversial. There was a better short-term curative effect and slighter complications for POEM as compared with the laparoscopic Heller myotomy from the trend of published literatures. However, it’s long-term effects for these two treatment models were not clarified. Conclusions Both laparoscopic Heller myotomy and POEM are medicable for AC. POEM as a new treatment of AC shows some advantages of minimal invasion and exact efficacy, but it needs to be followed-up for a long-term. Treatment model for AC is chosen on basis of typing under endoscope, physical fitness, anatomy of easophagus, previous history, tolerance of surgery and other factors.
ObjectiveTo compare the clinical effect of laparoscopic Heller myotomy (LHM) combined with Dor fundoplication and peroral endoscopic myotomy (POEM) in treatment of patients with achalasia.MethodsThe clinical data of 67 patients with achalasia from January 2014 to December 2018 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed. Among them, 19 patients received the LHM combined with Dor fundoplication (LHM group), 48 patients received the POEM (POEM group). The clinical efficacy and safety of the two groups were compared.ResultsThere were no significant differences in the baseline data such as the gender, age, course of disease, body mass index, preoperative Eckardt score, preoperative maximum diameter of esophagus, and previous treatment history between the two groups (P>0.05). There were no significant differences in the operation time, bleeding volume, the Eckardt points at 3 and 12 months after operation, the decrease degree of maximum diameter of esophagus, complications (except for gastroesophageal reflux, P=0.029), and recurrence rate between the two groups (P>0.05). The total hospitalization time, postoperative hospitalization time, and total hospitalization costs of the POEM group were lower than those of the LHM group (P<0.05).ConclusionsBoth LHM and POEM could effectively relieve clinical symptoms, short-term efficacy and safety of the two kinds of operations are similar. Postoperative recovery of POEM is fast and hospitalization cost is less, but incidence of gastroesophageal reflux is higher.