title: Predictors of long-term outcome after laparoscopic esophagomyotomy and Dor fundoplication for achalasia.
abstract: OBJECTIVE
  To identify predictors of long-term outcome of laparoscopic Heller myotomy for achalasia, including predictors of heartburn and recurrent dysphagia, which occasionally develop postoperatively.
  
  
  METHODS
  Retrospective review using interviews of patients.
  
  
  METHODS
  Academic university hospital.
  
  
  METHODS
  One hundred sixty-five patients with achalasia who underwent a laparoscopic esophagomyotomy and Dor fundoplication.
  
  
  METHODS
  Dysphagia and heartburn before and after the operation were assessed on a 4-point Likert scale, as were postoperative dilations, reoperations, and antacid use. Potential predictors were age, race, sex, body mass index, weight loss, duration of symptoms, manometry findings, esophageal diameter, previous treatment, and operative technique.
  
  
  RESULTS
  Follow-up averaged 62 (range, 1-174) months. Dysphagia frequency was once a week or less in 128 patients (78%), several times per week in 25 (15%), and daily in 12 (7%). Satisfaction scores averaged 3.7 on a 4-point scale. Thirty patients (18%) required a postoperative dilation, and 6 (4%) underwent another operation. The only predictor of postoperative dysphagia was duration of symptoms longer than 10 years (odds ratio, 0.2; P = .03). Preoperative dilations predicted the need for postoperative dilations (odds ratio, 2.4; P = .03). Only 20 patients (12%) reported heartburn more than once weekly, although 75 (45%) reported taking antacids. No variable predicted postoperative heartburn or antacid use.
  
  
  CONCLUSIONS
  Long-term outcomes after laparoscopic esophagomyotomy were excellent across a wide spectrum of disease severity and presentations. Previous treatments, such as balloon dilation or botulinum toxin (Botox) injection, did not portend worse outcomes. When the myotomy was extended 2 cm onto the stomach and a Dor fundoplication was performed, severe heartburn was rare.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA 94143-0790, USA. jonathan.carter@ucsfmedctr.org
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Carter
authors.forename: Dennis
authors.initials: D
authors.lastname: Nguyen
authors.forename: Garrett R
authors.initials: GR
authors.lastname: Roll
authors.forename: Sandi W
authors.initials: SW
authors.lastname: Ma
authors.forename: Lawrence W
authors.initials: LW
authors.lastname: Way
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods; D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult