title: Factors affecting quality of life after minimally invasive Heller myotomy for achalasia.
abstract: The effect of prior nonoperative treatment, type of fundoplication, and surgical approach on quality of life after minimally invasive Heller myotomy (MIHM) for achalasia in not known. MIHM for achalasia was performed in 105 patients (primary 102; redo 3). Sixty-five patients had prior nonoperative treatment (dilations in 41; botulinum toxin injections in 13; dilations and botulinum toxin injections in 11). Primary laparoscopic MIHM with fundoplication (Dor in 32; Toupet in 56) was performed in 88 patients and thoracoscopic MIHM without fundoplication in 14. Achalasia and quality-of-life-related symptoms were evaluated prospectively with a visual analogue scoring scale. Median follow-up was 25 months. There was a trend toward a higher incidence of intraoperative esophageal perforation and recurrent dysphagia in patients with prior nonoperative treatment. Patients with prior nonoperative treatment had significant improvement in achalasia-related symptoms postoperatively. Patients with prior botulinum toxin injections with or without dilations had no improvement in quality of life after MIHM. The operative success of MIHM may be compromised if prior nonoperative treatment is used. Botulinum toxin injections may blunt the beneficial effect of MIHM on quality of life. The outcome of MIHM is good regardless of the type of fundoplication or surgical approach.
authors.affiliation: Department of Minimally Invasive Surgery, Western Pennsylvania Allegheny Health System, 494 Gettysburg Street, Pittsburgh, PA 15206-4530, USA. iraftopoloulos@hotmail.com
authors.forename: Yannis
authors.initials: Y
authors.lastname: Raftopoulos
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Landreneau
authors.forename: Fernando
authors.initials: F
authors.lastname: Hayetian
authors.forename: Pavlos
authors.initials: P
authors.lastname: Papasavas
authors.forename: Keith S
authors.initials: KS
authors.lastname: Naunheim
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hazelrigg
authors.forename: Ricardo
authors.initials: R
authors.lastname: Santos
authors.forename: Daniel
authors.initials: D
authors.lastname: Gagné
authors.forename: Philip
authors.initials: P
authors.lastname: Caushaj
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Keenan
mesh_terms: D001905:Botulinum Toxins / Q000627:therapeutic use; D002404:Catheterization; D003680:Deglutition Disorders / Q000523:psychology / Q000601:surgery / Q000628:therapy; D004931:Esophageal Achalasia / Q000523:psychology* / Q000601:surgery* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D013906:Thoracoscopy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins