title: [Laparoscopic approach of achalasia. Long-term clinical and functional results and quality of life].
abstract: BACKGROUND
  Laparoscopic Heller myotomy has become the gold standard procedure for patients with achalasia. This study evaluates the clinical status, quality of life, and functional outcomes after laparoscopic Heller myotomy.
  
  
  METHODS
  We analyzed patients who underwent laparoscopic Heller myotomy with an associated anti-reflux procedure from October 1998 to December 2010. Before surgery, we administered a clinical questionnaire and as of 2002, we also evaluated quality of life using a specific questionnaire (GIQLI). In 2011, we performed a follow up for all available patients. We administered the same clinical questionnaire and quality of life test as before surgery and performed manometry and 24-hour pH monitoring. According to the length of follow up, patients were divided into 3 groups. Group 1 with a follow-up between 6 and 47 months; group 2 follow-up between 48 and 119 months, and group 3 with a follow-up of more than 120 months). Moreover, 27 patients had already been evaluated with this same protocol in 2003. Pre- and postoperative data were compared for the 3 groups and for patients who completed follow up in 2003 and 2011.
  
  
  RESULTS
  Ninety-five patients underwent laparoscopic Heller myotomy. Seventy-six (80%) were available for follow-up. Mean follow-up was 56 months (range 6-143). Global improvement in dysphagia was 89%. Total DeMeester score decreased in the 3 groups. GIQLI scores improved after surgery, reaching normal values. Manometric determinations showed normal LES pressures after myotomy in the 3 groups. Ten percent of overall 24-hour pH monitoring was abnormal. The group of patients followed up in 2003 and in 2011 showed no impairment in the variables studied in the long term.
  
  
  CONCLUSIONS
  Long-term follow up of the laparoscopic approach to achalasia showed good results concerning clinical status and quality of life, with normal sphincteric pressures and a low incidence of gastroesophageal reflux.
authors.affiliation: Departmento de Cirugía y Digestología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España.
authors.forename: Franco G
authors.initials: FG
authors.lastname: Marinello
authors.affiliation: Departmento de Cirugía y Digestología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España. Electronic address: etargarona@santpau.cat.
authors.forename: Eduardo M
authors.initials: EM
authors.lastname: Targarona
authors.affiliation: Departmento de Cirugía y Digestología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España.
authors.forename: Carmen
authors.initials: C
authors.lastname: Balague
authors.affiliation: Departmento de Cirugía y Digestología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España.
authors.forename: María
authors.initials: M
authors.lastname: Poca
authors.affiliation: Departmento de Cirugía y Digestología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España.
authors.forename: Joan
authors.initials: J
authors.lastname: Mones
authors.affiliation: Departmento de Cirugía y Digestología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona (UAB), Barcelona, España.
authors.forename: Manuel
authors.initials: M
authors.lastname: Trias
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D020127:Recovery of Function; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Acalasia; Achalasia; Laparoscopia; Laparoscopy; Largo plazo; Long-term