Laparoscopic Management of Achalasia: Medium-term Outcomes After Heller Myotomy and Fundoplication

INTRODUCTION– Achalasia is an uncommon disease of unknown origin. Management is challenging. Laparoscopic esophageal myotomy is the best treatment option, having variable results. We report the medium-term outcomes on 16 patients after Laparoscopic Heller myotomy and partial fundoplication.
METHODS AND PROCEDURES– This is a descriptive, retrospective study evaluating the clinical outcomes of all patients undergoing laparoscopic Heller myotomy and partial fundoplication for achalasia in two hospitals affiliated to our university from February 2000 to January 2008.
RESULTS– A total of 18 patients had surgery for achalasia. 2 patients were lost on follow up. We interviewed and reviewed the medical records of 16 patients. Mean follow-up was 30.6 months (range 3-96). Mean length of hospital stay was 3.1 days (1-5). There was no mortality and no conversion to open surgery was necessary. All patients had subjective improvement of symptoms and quality of life, as evaluated by a visual analogue scale. The mean score was 8.2/10 (range 6-10). After an average of six months, symptoms occurred in 14 patients (87.5%): heartburn in 8 (57.1%), regurgitation in 7 (50%) and dysphagia in 6 (42.8%), all of them considered as mild. Six patients required additional therapy, one (6.25%) needed reoperation for recurrence of symptoms (severe dysphagia), and 5 (31%) received proton pump inhibitors. All patients experienced weight gain (mean 5.8 kg)
CONCLUSION– Laparoscopic Heller myotomy is the treatment of choice for achalasia, with low morbidity and mortality. Despite the high rate of symptoms recurrence, patients perceived an improvement in their quality of life and gained weight. The results of our series compare favorably with other treatment options reported in the literature.

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Program Number: P320

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