Impact of lower oesophageal sphincter pressure on surgical outcomes in achalasia cardia: A comparative study

Introduction: Laparoscopic Heller myotomy (LHM) is the preferred treatment approach to reducing lower oesophageal sphincter pressure (LOSP). However, less than half of the patients show high LOSP. This study primarily aims to evaluate how LOSP affects operative results. Patients and Methods: From 2019 to 2023, a total of 52 patients were treated with LHM combined with partial fundoplication, diagnosed by integrated relaxing pressure (IRP) >15 mmHg on high-resolution manometry (HRM). Based on HRM, patients were assigned into two arms: normal LOSP (≤35 mmHg, n = 30) and high LOSP (>35 mmHg, n = 22). Symptoms were assessed preoperatively, and the median duration of follow-up of 24 months using the Eckardt score (ES), the achalasia-specific quality of life (ASQ) score and the SF-36 questionnaire quality of Life (QOL). Treatment failure was defined as ES ≥4 or an ASQ score ≥16. Results: Pre-operative Eckardt and ASQ scores were similar between groups. The high LOSP group had significantly younger populations (≤50 years: 90.90% vs. 60%, P = 0.013). The normal LOSP group had significantly less dysphagia ( P = 0.007) and regurgitation ( P = 0.011), reflecting significantly lower post-operative ES (0.80 vs. 2.00, P = 0.002). In addition, post-operative ASQ scores (11 vs. 14, P = 0.005) and QOL were significantly better in the normal LOSP group. The high LOSP group experienced a significantly greater failure rate (31.80% vs. 6.7%, P = 0.027). Conclusion: Normal LOSP results in better surgical outcomes and QOL, as younger patients with high LOSP have poorer responses, due to higher LOS muscle tone.