Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

Abstract

Objective: To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia. Methods: Thirty-nine patients with achalasia (25 males, mean age 42^13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1 ¼ no symptoms; 4 ¼ persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30^34 mmHg. Six patients had undergone previous pneumatodilation. Results: No procedure related mortality was recorded. Mean follow-up was 107^30 months (54 -177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3^8.3 mmHg ðP , 0:001Þ; in oesophageal width was 11.5^7.1 mm ðP , 0:001Þ; in dysphagia 1.8^0.8 ðP , 0:01Þ and regurgitation 1.4^0.7 ðP , 0:01Þ: Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement ðP , 0:001Þ especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure. Conclusion: Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia. q

SAGES guidelines for the surgical treatment of esophageal achalasia

“…Patient quality of life has been demonstrated to be significantly improved after myotomy in several studies [51][52][53][54], and patient satisfaction rates with surgery have consistently been reported to exceed 80-90% [44,47].…”

Management of achalasia

“…The advantage of a less invasive, safe, and effective surgical option prompts gastroenterologists to choose patients earlier for surgery, because this obviates the need for dilation 44,45…”

Review article: the management of achalasia – a comparison of different treatment modalities1

“…60 Long-term follow-up has shown that dysphagia relapse rates may be as low as 8-10% from 6 to 9 years after surgery. 60,61 However, the advent of minimally invasive surgical techniques to treat achalasia has dramatically altered the management algorithm for many gastroenterologists. The advantage of a less invasive, safe and effective surgery entices many gastroenterologists to send their patients to surgery early after the initial diagnosis of achalasia as this obviates the need for dilatation and the inherent risk of oesophageal perforation.…”