Early results of laparoscopic Heller myotomy do not necessarily predict long-term outcome.
BACKGROUND
We sought to evaluate how patients' symptoms evolve after laparoscopic Heller myotomy.


METHODS
Before and after laparoscopic Heller myotomy, 88 patients graded dysphagia and heartburn on a Likert scale (0 = none; 5 = severe). Patients graded outcomes as excellent, good, fair, or poor. Outcomes were compared in the same patients at 1 and 3 years of follow-up.


RESULTS
At early follow-up (10.6 +/- 7.8 months) significant reductions were noted in dysphagia (11% versus 100%), dysphagia scores (0.6 +/- 1.1 versus 4.7 +/- 0.7), heartburn (31% versus 72%), and heartburn scores (1.2 +/- 1.6 versus 2.7 +/- 1.9). By late follow-up (37.6 months +/- 18.0) these values increased (47%, 1.9 +/- 1.7, 48%, 1.8 +/- 1.5, respectively) but remained significantly reduced compared with before operation. Excellent/good outcomes at early and late follow-up were 89% and 85%, respectively (P = not significant).


CONCLUSIONS
Laparoscopic Heller myotomy is highly effective at palliating the symptoms of achalasia. With time, symptoms may recur owing to esophageal dysmotility, mandating continued surveillance.
Department of Surgery, University of South Florida, P.O. Box 1289, Room F-145, Tampa, FL 33601, USA. arosemur@hsc.usf.edu
Mark
M
Bloomston
Alan
A
Durkin
H Worth
HW
Boyce
Milton
M
Johnson
Alexander S
AS
Rosemurgy
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D013505:Digestive System Surgical Procedures / Q000379:methods; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000601:surgery*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology; D011237:Predictive Value of Tests; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods