Paper presented
Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia

Presented at the 57th Annual Meeting of the Southwestern Surgical Congress, San Antonio, Texas, April 10–12, 2005
https://doi.org/10.1016/j.amjsurg.2005.08.012Get rights and content

Abstract

Background

Treatment options for achalasia include medications, endoscopic balloon dilation, injection of botulinum toxin, or surgery.

Methods

The clinical course of 75 consecutive patients who underwent minimally invasive Heller myotomy and partial fundoplication for achalasia between 1991 and 2001 was reviewed by means of a questionnaire.

Results

Mean follow-up was 5.3 (range .8 to 10.9) years. Sixty-four percent of questionnaires were returned. Thirty-seven patients (84%) felt much better and 6 (14%) slightly better; 1 (2%) rated the result as unchanged. Twenty-six patients (59%) experienced weight gain. Seven patients (16%) had persistent swallowing problems and 5 (11%) reported frequent reflux. Twenty-five percent underwent additional therapy, including dilation (n = 8, 18%), repeat surgery (n = 2, 5%), and botulinum toxin injection (n = 2, 5%). Eighteen patients (41%) were using a proton pump inhibitor or H2 blocker, three were on a calcium channel blocker (7%), and 1 was using nitroglycerine (2%).

Conclusion

Laparoscopic Heller myotomy can achieve short- and long-term results comparable to open surgery and should be considered the treatment of choice for patients suffering from achalasia. Despite the frequent need for further therapy, patient satisfaction is good.

Section snippets

Patient population

All consecutive patients with achalasia who underwent minimally invasive surgical treatment by a single surgeon (R.A.H.) between January 1991 and December 2001 were included in this study. There were a total of 75 patients, 34 men and 41 women, with a median age of 47 years (range 15 to 80). The medical record of all individuals was reviewed for demographics, symptoms, surgical technique, outcome, and complications. Table 1 shows demographic and clinical data of the study cohort.

Surgical procedure

During the

Results of surgery

There was no mortality and no conversion to open surgery was necessary. In 3 cases, early in our experience, an inadvertent mucosal perforation occurred, which was laparoscopically oversewn without adverse consequence in all cases. No surgical complications were observed and mean hospitalization was 1.8 days (range 1 to 6, SD ± 1.1).

A total of 47 replies (64%) were obtained. Three patients (6%) died of unrelated causes during the follow-up period. A total of 44 questionnaires could be

Comments

This retrospective study demonstrates that minimal invasive surgery for achalasia is effective long-term therapy, but many of the patients required additional treatment [26]. The need for further therapy is a reflection of the fact that few patients will regain normal esophageal body function and many will have persistent dysphagia or heartburn. Symptoms of achalasia have usually been present for many years before surgery, resulting in a destruction of esophageal body function [1], [3].

Despite

Acknowledgment

Dr. Bonatti was sponsored by the Detiger Fellowship.

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