Minimally invasive myotomy for achalasia in the elderly.
BACKGROUND
Elderly patients with achalasia are more frequently being referred for minimally invasive Heller myotomy (MIM). The associated morbidity and mortality of MIM in the elderly are not well defined. The objective of this study was to review our experience with MIM in the elderly.


METHODS
We identified a total of 57 patients (32 men, 25 women) 70 years or older (mean age 78 years, range 70 to 96 years) who underwent MIM [55 laparoscopically (LAP), 2 videothoracoscopically (VATS)] for achalasia at our institution. Clinical outcomes were analyzed including postoperative surgical interventions (redo myotomy, esophagectomy), and dysphagia scores (range: 1, no dysphagia to 5, dysphagia to saliva).


RESULTS
Thirty-seven (59.6%) patients had prior endoscopic therapy. There was no perioperative mortality and median hospital stay was 3 days. There were three (5.3%) conversions to open due to adhesions and concern regarding the viability of the myotomy following repair of a small perforation. A total of 11 (19.3%) patients had complications, including three (5.3%) intraoperative esophageal perforations, three pleural effusions, one (1.8%) pneumonia, one intraoperative gastric perforation, one C. difficile infection, one ileus, and one postoperative intubation. Mean follow-up was 23.5 months. Mean dysphagia score improved from 3.38 preoperatively to 1.36 following MIM (p < 0.0001), with 55 (96.5%) patients experiencing an improvement. Reoperation for recurrent dysphagia was required in four (7.0%) of the patients.


CONCLUSIONS
MIM can be performed safely in elderly patients with achalasia in centers with significant experience in laparoscopic foregut surgery. MIM affords similar symptomatic improvement in the elderly as compared to younger patients. MIM should be seriously considered as a therapeutic strategy in elderly achalasia patients.
Kilic
Arman
A
Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, 200 Lothrop St., Suite C-800, Pittsburgh, PA, Pennsylvania, 15261, USA.
Schuchert
Matthew J
MJ
Pennathur
Arjun
A
Landreneau
Rodney J
RJ
Alvelo-Rivera
Miguel
M
Christie
Neil A
NA
Gilbert
Sebastien
S
Abbas
Ghulam
G
Luketich
James D
JD
D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D006801:Humans; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D016896:Treatment Outcome; D020535:Video-Assisted Surgery