title: Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience.
abstract: OBJECTIVE
  To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia.
  
  
  METHODS
  Thirty-nine patients with achalasia (25 males, mean age 42+/-13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1=no symptoms; 4=persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30+/-34 mmHg. Six patients had undergone previous pneumatodilation.
  
  
  RESULTS
  No procedure related mortality was recorded. Mean follow-up was 107+/-30 months (54-177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3+/-8.3 mmHg (P < 0.001) in oesophageal width was 11.5+/-7.1 mm (P < 0.001) in dysphagia 1.8+/-0.8 (P < 0.001) and regurgitation 1.4+/-0.7 (P < 0.001) Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement (P < 0.001) especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure.
  
  
  CONCLUSIONS
  Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia.
authors.affiliation: Division of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy. mineo@med.uniroma2.it
authors.forename: Tommaso Claudio
authors.initials: TC
authors.lastname: Mineo
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ambrogi
mesh_terms: D000328:Adult; D003680:Deglutition Disorders / Q000601:surgery; D018572:Disease-Free Survival; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000534:rehabilitation / Q000601:surgery*; D004943:Esophagogastric Junction / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011859:Radiography; D012720:Severity of Illness Index; D016896:Treatment Outcome