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

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

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Bibliographic Details
Published in:The American journal of surgery 2005-12, Vol.190 (6), p.883-887
Main Authors: Bonatti, Hugo, Hinder, Ronald A., Klocker, Josef, Neuhauser, Beate, Klaus, Alexander, Achem, Sami R., de Vault, Kenneth
Format: Article
Language:English
Subjects:
Abdomen
Achalasia
Adolescent
Adult
Aged
Aged, 80 and over
Biological and medical sciences
Botulinum toxin
Digestive system. Abdomen
Dysphagia
Endoscopy
Esophageal Achalasia - surgery
Esophagus
Female
Follow-Up Studies
Fundoplication
Fundoplication - methods
Gastroesophageal reflux
General aspects
Health care
Heller myotomy
Humans
Investigative techniques, diagnostic techniques (general aspects)
Laparoscopy
Male
Medical sciences
Medical treatment
Middle Aged
Mortality
Muscle, Smooth - surgery
Pain
Patient Satisfaction
Patients
Postoperative period
Quality of life
Questionnaires
Retrospective Studies
Stomach - surgery
Surgery
Surgical outcomes
Surveys and Questionnaires
Time Factors
Treatment Outcome
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Summary:Treatment options for achalasia include medications, endoscopic balloon dilation, injection of botulinum toxin, or surgery. 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. 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%). 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.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2005.08.012