Jon M Harrison, MD1, Stephen M Doane, MD2, Michael J Pucci, MD, FACS2, Francesco Palazzo, MD, FACS2, Karen A Chojnacki, MD, FACS2. 1Massachusetts General Hospital, 2Thomas Jefferson University Hospital
INTRODUCTION: We sought to describe outcomes related to symptom resolution and weight change following surgical intervention in obese patients suffering from achalasia.
METHODS and PROCEDURES: A retrospective chart review was performed of 252 consecutive patients receiving laparoscopic Heller myotomy with Dor fundoplication by a single surgeon over a twelve-year period. Nine (9) of these patients (4%) had a preoperative BMI > 40 kg/m2. Five (5) of these morbidly obese patients responded to a follow-up survey evaluating symptom resolution, impressions of their disease management, and overall satisfaction. A paired t-test was used to compare mean pre- and post-operative weight changes.
RESULTS: Follow-up duration ranged from 20-144 months. Preoperative Eckardt scores for these patients ranged between 2 and 6. There were no perioperative complications. All patients reported postoperative improvement of dysphagia. By the time of long-term follow-up, Eckardt scores ranged between 0 and 6, with 80% of patients reporting recurrence of symptoms. One (1) patient has since required pneumatic dilation to manage her symptoms. The average change in BMI was -0.96 kg/m2 and was not statistically significant (p = 0.72, CI: -5.8 to 7.7). 60% of patients were satisfied with the surgery, and 80% wished they had received a simultaneous bariatric procedure.
CONCLUSION: Laparoscopic Heller myotomy for achalasia in morbidly obese patients appears safe and to have comparable outcomes to patients with a normal BMI but does not appear to produce substantial weight change. The option of concomitant bariatric surgery should be discussed with patients preoperatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77304
Program Number: P359
Presentation Session: Poster (Non CME)
Presentation Type: Poster