title: Outcomes after minimally invasive esophagomyotomy.
abstract: BACKGROUND
  Thoracic surgeons traditionally performed thoracotomy and myotomy for achalasia. Recently minimally invasive approaches have been reported with good success. This report summarizes our single-institution experience using video-assisted thoracoscopy (VATS) or laparoscopy (LAP) for the treatment of achalasia.
  
  
  METHODS
  A review of 62 patients undergoing minimally invasive myotomy for achalasia was performed. There were 27 male and 35 female patients. Mean age was 53 years (range 14 to 86). Thirty-seven (59.7%) had failed prior treatments (balloon dilation, botulinim toxin injection, or prior surgery). Outcomes studied were dysphagia score (1 = none, 5 = severe), Short-Form 36 quality of life (SF36 QOL) score, and heartburn-related QOL index (HRQOL).
  
  
  RESULTS
  Surgery included myotomy and partial fundoplication (5 VATS and 57 LAP). Mortality was zero, and complications occurred in 9 (14.5%) patients. There were 6 perforations (4 repaired by LAP and 2 open). Median length of stay was 2 days, time to oral intake was 1 day. At a mean of 19 months follow-up, 92.5% of patients were satisfied with outcome. Dysphagia scores improved from 3.6 to 1.5 (p < 0.01) but 3 patients ultimately required esophagectomy for recurrent dysphagia. HRQOL scores for heartburn and SF-36 QOL scores were comparable with control populations.
  
  
  CONCLUSIONS
  Minimally invasive myotomy and partial fundoplication for achalasia improved dysphagia in 92.5% of patients with heartburn and QOL scores were comparable with normal values at 19-month follow-up. The laparoscopic approach offers excellent results and was the preferred approach by our thoracic group for treating achalasia. Thoracic residency training should strive to include laparoscopic esophageal experience.
authors.affiliation: University of Pittsburgh Medical Center Health System, Pennsylvania, USA. luketichjd@msx.upmc.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Luketich
authors.forename: H C
authors.initials: HC
authors.lastname: Fernando
authors.forename: N A
authors.initials: NA
authors.lastname: Christie
authors.forename: P O
authors.initials: PO
authors.lastname: Buenaventura
authors.forename: R J
authors.initials: RJ
authors.lastname: Keenan
authors.forename: S
authors.initials: S
authors.lastname: Ikramuddin
authors.forename: P R
authors.initials: PR
authors.lastname: Schauer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D004944:Esophagoplasty / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009130:Muscle, Smooth / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome