Comparison between subjective and objective assessment of the long-term results after the Heller-Dor operation in patients affected by oesophageal achalasia.
BACKGROUND
Nowadays the subjective assessment of Health-Related Quality of Life after surgery for achalasia is often associated with the instrumental methods in order to evaluate long-term results of therapy.


OBJECTIVE
To assess the long-term objective and subjective results of the surgical treatment of achalasia and to study the correlation between clinical-instrumental methods and those based on the patient's self-assessment and on Health-Related Quality of Life questionnaires.


METHODS
One hundred and twenty-four patients consecutively submitted to trans-abdominal Heller-Dor operation were periodically followed up with clinical examination, endoscopy, barium swallow and manometry. The Health-Related Quality of Life was assessed using the 36 item short form (SF-36) and the Psychological General Well-Being Index questionnaire. The statistical comparison between the results of the self-assessment questionnaires and the long-term clinical-instrumental result was calculated by means of linear regression analysis.


RESULTS
Over the years, 123 patients underwent at least one complete clinical-instrumental check-up and filled the self-assessment questionnaires. Mean follow-up was 105 months (range 12-288) with a median of 82.5 months. The result of the surgery was considered satisfactory in 93.5% of the patients, while the reflux oesophagitis observed in 6.5% of the cases was the main cause of failure. Clinical scores for dysphagia and for gastro-oesophageal reflux symptoms were significantly reduced after surgery. The results of the SF-36 and Psychological General Well-Being Index questionnaires were in our population very high and clinical correlation (p<0.05) emerged in physical function, in role physical, in mental health and in vitality domains of SF-36 questionnaire, and in self-control and general health scales of Psychological General Well-Being Index questionnaire.


CONCLUSIONS
Health-Related Quality of Life questionnaires can be considered valid aids in evaluating surgical results, but the clinical-instrumental evaluation remains the cardinal point of every long-term assessment in order to diagnose complications, the disease-related conditions of the patient and to acquire reliable data on which scientific discussion can be based.
Mattioli
S
S
Division of Oesophageal and Pulmonary Surgery, Villa Maria Cecilia Hospital, and Center for the Study and Therapy of Diseases of the Oesophagus (Surgical Section), University of Bologna, Bologna, Italy. sandro.mattioli@unibo.it
Ruffato
A
A
Di Simone
M P
MP
Lugaresi
M L
ML
D'Ovidio
F
F
D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004931:Esophageal Achalasia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005773:Gastroscopy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012720:Severity of Illness Index; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome