title: Laparoscopic Heller myotomy can be used as primary therapy for esophageal achalasia regardless of age.
abstract: BACKGROUND
  Laparoscopic Heller-Dor surgery is the current treatment of choice for patients with esophageal achalasia, but elderly patients are generally referred for less invasive treatments (pneumatic dilations or botulinum toxin injections).
  
  
  OBJECTIVE
  To assess the effect of age on the surgical outcome of patients receiving laparoscopic Heller-Dor as primary treatment.
  
  
  METHODS
  Demographic and clinical findings were prospectively collected on patients undergoing laparoscopic Heller-Dor from 1992 to 2012. Patients were classified in three age brackets: group A (≤45 years), group B (45-70), and group C (≥70). Treatment was defined as a failure if the postoperative symptom score was >10th percentile of the preoperative score (i.e., >8). We consecutively performed the Heller-Dor in 571 achalasia patients, 305 (53.4 %) in group A, 226 (39.6 %) in group B, and 40 (7 %) in group C.
  
  
  RESULTS
  The mortality was nil; the conversion and morbidity rates were both 1.1 %. Group C patients had higher preoperative symptom scores (p = 0.02), while the symptom duration was similar in all three groups. Mucosal tears occurred in 17 patients (3 %): 6 (2 %) in group A, 8 (3.5 %) in group B, and 3 (7.5 %) in group C (p = 0.09). The postoperative hospital stay was slightly longer for group C (p = 0.06).
  
  
  CONCLUSIONS
  The treatment failure rate was quite similar: 31 failures in group A (10.1 %), 19 in group B (8.4 %), and 3 in group C (7.5 %; p = 0.80). These failures were seen more in manometric pattern III (22.2 %, p = 0.002). Laparoscopic Heller-Dor can be used as the first therapeutic approach to achalasia even in elderly patients with an acceptable surgical risk.
authors.affiliation: Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Salvador
authors.forename: Mario
authors.initials: M
authors.lastname: Costantini
authors.forename: Francesco
authors.initials: F
authors.lastname: Cavallin
authors.forename: Lisa
authors.initials: L
authors.lastname: Zanatta
authors.forename: Elena
authors.initials: E
authors.lastname: Finotti
authors.forename: Cristina
authors.initials: C
authors.lastname: Longo
authors.forename: Loredana
authors.initials: L
authors.lastname: Nicoletti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capovilla
authors.forename: Romeo
authors.initials: R
authors.lastname: Bardini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Zaninotto
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D004931:Esophageal Achalasia / Q000503:physiopathology / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000503:physiopathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D022125:Lacerations / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D008297:Male; D008365:Manometry; D008875:Middle Aged; D009092:Mucous Membrane / Q000293:injuries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017211:Treatment Failure
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