Improvement in Mental Health and Social Functioning After Laparoscopic Heller Myotomy for Achalasia

Steven Lorch, MD, Vic Velanovich, MD. University of South Florida College of Medicine.

Introduction-
Achalasia is a benign but debilitating primary esophageal motility disorder which may have a significant detriment on patients’ mental health and social functioning. The gold standard for treatment is Heller myotomy with partial fundoplication. Treatment is aimed at palliation of symptoms with the hope for improved quality of life. Our aim was to objectively determine improvements in mental health and social functioning as measured by the Short Form 36 (SF-36) questionnaire after Heller myotomy for achalasia.

Methods and Procedures-
Between August 2011 and September 2013 data was prospectively collected on patients undergoing Heller myotomy. Patients included in analysis underwent laparoscopic Heller myotomy with partial fundoplication for a preoperative diagnosis of achalasia. Patients underwent pre and postoperative evaluation during which health status, including mental health and social functioning, was assessed using the SF-36 questionnaire (minimum score 0, maximum score 100). SF-36 scores are presented as median with interquartile range. Statistics were performed using the Wilcoxon signed rank test.

Results-
64 patients underwent Heller myotomy. Of these, 21 underwent laparoscopic Heller myotomy with partial fundoplication for a diagnosis of achalasia and had all preoperative and postoperative SF-36 scores calculated. 12 of these patients were male and 9 were female. Mean patient age was 58.6 +/- 17.5 years. 4 patients underwent conversion from laparoscopic to an open procedure. When preoperative and postoperative data was compared, a significant increase in median mental health scores (80 [60-80] versus 88 [84-96], p=0.0005) as well as social functioning scores (75 [50-100] versus 100 [87.5-100], p=0.025) was observed.

Conclusion-
Heller myotomy with partial fundoplication may lead to improvement in quality of life for patients with achalasia. Specifically, we observed improvements in mental health and social functioning as measured by the SF-36 questionnaire.

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