title: Myotomy: follow-up study of 50 patients.
abstract: Laparoscopic myotomy has become the standard treatment for definitive management of achalasia. This study was undertaken to assess the long-term results of the procedure. Perioperative data, including a symptom score questionnaire, were collected prospectively on all patients undergoing laparoscopic myotomy. The same questionnaire was readministered by phone to patients with follow-up greater than 3.75 years. The long-term success of myotomy was defined as a 50% or greater decrease in the dysphagia score and absence of further therapy (responders). Fifty of 95 patients (age = 57 years, 23 females) were successfully contacted. Average follow-up was 6.2 years. The overall long-term success rate was 64% (responders). Forty-two patients (84%) were able to gain or maintain their weight after the procedure. Five patients (10%) required one or more endoscopic dilations after the myotomy. The mean change in dysphagia score was higher in the responder group (7.8 +/- 1.9 vs. 1.9 +/- 2.1; P = 0.001). The two groups were similar in terms of age, gender distribution, and follow-up interval (P > .05). Dor fundoplication was performed in six patients (12%), and the outcome comparisons of these patients showed no significant differences from those patients undergoing Heller alone. Overall satisfaction was achieved in 94% of contacted patients. These results confirm that laparoscopic myotomy is an effective procedure with excellent long-term symptom resolution and overall satisfaction in patients with achalasia.
authors.affiliation: Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
authors.forename: Barry R
authors.initials: BR
authors.lastname: Berch
authors.forename: R Dean
authors.initials: RD
authors.lastname: Nava
authors.forename: Alfonso
authors.initials: A
authors.lastname: Torquati
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Sharp
authors.forename: William O
authors.initials: WO
authors.lastname: Richards
mesh_terms: D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000601:surgery; D011446:Prospective Studies; D013906:Thoracoscopy