{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:37:49Z","timestamp":1790015869267,"version":"4.0.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T00:00:00Z","timestamp":1769040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Laparoscopic Heller Myotomy with Dor fundoplication is the most effective therapeutic option for Achalasia cardia, with fewer complications. We present the outcomes of this procedure with long-term follow-up in patients with Achalasia cardia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single institution prospectively maintained data of Laparoscopic Heller Myotomy with Dor fundoplication between January 2014 and January 2024 was reviewed. Eckardt scores at three-time points (preoperative, 3-month, and long-term follow-up) were used to assess treatment efficacy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 16 patients had a median age of 34 years. Megaesophagus was observed in 8 (50%) patients, and 5 patients had sigmoid esophagus. The mean operative time was 162\u2009\u00b1\u200941\u2005min. The mean myotomy length was 6.1\u2005cm and 2.19\u2005cm, respectively, for the esophagus and the stomach. Following the surgery, there was significant improvement in the Eckardt score from a median preoperative score of 9 (5\u201312) to a median postoperative score of 2(0\u20134) in 3 months (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001) and a median Eckardt score of 1.5 (0\u20133) in long-term follow-up (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.001). The median long-term follow-up was 32 months (12\u201360 months). Overall, two treatment failure was observed, and one required endoscopic balloon dilatation. The gastroesophageal reflux (uncomplicated) was observed in 5 (31.2%) patients. The symptoms were mild, and none had reflux-related complications at the last follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LHM provides immediate and durable symptomatic relief with fewer complications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1678605","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T06:52:14Z","timestamp":1769064734000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Laparoscopic Heller myotomy with Dor fundoplication for achalasia: an outcome in a tertiary health center of Nepal"],"prefix":"10.3389","volume":"13","author":[{"given":"Kunal Bikram","family":"Deo","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal Surgery, B P Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parbatraj","family":"Regmi","sequence":"additional","affiliation":[{"name":"Department of Surgery, BP Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narendra","family":"Pandit","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, B P Koirala Institute of Health Sciences","place":["Dharan, Nepal"]},{"name":"Department of Surgical Gastroenterology, Birat Medical College and Teaching Hospital","place":["Biratnagar, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barurendra Raj","family":"Yogi","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, B P Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bed Prakash","family":"Sah","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, B P Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulav","family":"Budhathoki","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, B P Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shailesh","family":"Adhikary","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal Surgery, B P Koirala Institute of Health Sciences","place":["Dharan, Nepal"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1016\/J.SUC.2024.06.011","article-title":"Achalasia: diagnosis and management","volume":"105","author":"Provenza","year":"2025","journal-title":"Surg Clin of North Am"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/dote\/doy071","article-title":"The 2018 ISDE achalasia guidelines","volume":"31","author":"Zaninotto","year":"2018","journal-title":"Dis Esophagus"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e13287","DOI":"10.1111\/nmo.13287","article-title":"Evaluating the reliability and construct validity of the eckardt symptom score as a measure of achalasia severity","volume":"30","author":"Taft","year":"2018","journal-title":"Neurogastroenterol Motil"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2219","DOI":"10.1056\/nejmoa1905380","article-title":"Endoscopic or surgical myotomy in patients with idiopathic achalasia","volume":"381","author":"Werner","year":"2019","journal-title":"N Engl J Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"6513","DOI":"10.1007\/s00464-020-08148-5","article-title":"Over ten-year outcomes of laparoscopic Hellermyotomy with Dor-fundoplication with achalasia: single-center experience with annual endoscopic surveillance","volume":"35","author":"Fukushima","year":"2021","journal-title":"Surg Endosc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1097\/SLA.0b013e3181907bdd","article-title":"Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience","volume":"248","author":"Zaninotto","year":"2008","journal-title":"Ann Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/dote\/doab053","article-title":"Myotomy in sigmoid megaesophagus: is it applicable? 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