title: Outcomes of minimally invasive myotomy for the treatment of achalasia in the elderly.
abstract: BACKGROUND
  An increasing number of elderly patients diagnosed with achalasia are being referred for minimally invasive myotomy. Little data are available about the operative outcomes in this population. The objective of this study was to review our experience with this procedure in an elderly population.
  
  
  METHODS
  A retrospective review was performed of 51 consecutive patients, 65 years of age or older, diagnosed with achalasia who underwent a minimally invasive myotomy at our institution. Prior therapies, perioperative outcomes, and postoperative interventions were also analyzed.
  
  
  RESULTS
  Of the 51 patients, 28 (55%) had undergone prior endoscopic therapy, and 2 patients (7%) had a prior myotomy. Mean duration of symptoms was 10.9 years (range, 0.5 to 50). No perioperative mortality occurred, and the median hospital stay was 3 days. Two patients (3.8%) had complications, including a gastric mucosal injury and one atelectasia. Eleven patients (21%) required additional therapy postoperatively. Symptom improvement was described in all patients.
  
  
  CONCLUSIONS
  Laparoscopic Heller myotomy can safely be performed in elderly patients, providing significant symptom relief. No evidence suggests that surgery should not be considered a first-line treatment. Advanced age does not appear to adversely affect outcomes of laparoscopic Heller myotomy.
authors.affiliation: Mayo Clinic Hospital, 5777 East Mayo Boulevard, Phoenix, Arizona 85054, USA.
authors.forename: Randall O
authors.initials: RO
authors.lastname: Craft
authors.forename: Brenda E
authors.initials: BE
authors.lastname: Aguilar
authors.forename: Colleen
authors.initials: C
authors.lastname: Flahive
authors.forename: Marianne V
authors.initials: MV
authors.lastname: Merritt
authors.forename: Alyssa B
authors.initials: AB
authors.lastname: Chapital
authors.forename: Richard T
authors.initials: RT
authors.lastname: Schlinkert
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Harold
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D009130:Muscle, Smooth / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome