Achalasia--which method of treatment to choose for senior patients?
BACKGROUND
Achalasia is an uncommon illness affecting 1 per 100,000 patients a year. It encompasses a rare, primary motor disorder of the distal esophagus.


METHODS
Over the period 1998-2006, 115 patients underwent various treatments for achalasia; the subgroup of seniors consisted of 26 patients. Six patients of these (age 69.7 y) underwent a modified Heller cardiomyotomy due to failure of previous endoscopic interventions. Standard esophageal manometry and 24 hour pH metry were performed pre- and postoperatively.


RESULTS
Six senior patients with achalasia underwent a laparoscopic Heller myotomy. Average preoperative tonus of the LES was 55 mmHg, postoperative tonus of the LES decreased to 11 mmHg. We performed Toupet partial fundoplication in all patients; no microperforation of the esophagus was found in the preoperative esophagoscopy. We recorded minimal pathological gastroesophageal reflux in pH metry - the average preoperative DeMeester score was 8, postoperatively 10.5. Prolonged dysphagia was not present in any patient--preoperative GIQLI score was 94, postoperative score was 106. There was no mortality or morbidity in the group of the operated patients.


CONCLUSIONS
Our operational results and postoperative follow-up show that laparoscopic Heller myotomy with Toupet partial fundoplication is a safe and effective treatment and can be recommended as the method of first choice for senior patients with no contraindication for laparoscopic operation.
Kala
Z
Z
Faculty Hospital Brno, Department of Surgery, Brno, Czech Republic.
Weber
P
P
Marek
F
F
Procházka
V
V
Meluzínová
H
H
Dolina
J
J
Kroupa
R
R
Hep
A
A
D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004931:Esophageal Achalasia / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D009130:Muscle, Smooth / Q000601:surgery*