title: Efficacy and durability of robotic Heller myotomy for achalasia: patient symptoms and satisfaction at long-term follow-up.
abstract: BACKGROUND
  Laparoscopic Heller myotomy (LHM) has become the standard treatment for achalasia in the USA. Robot-assisted Heller myotomy (RHM) has emerged as an alternative approach due to improved visualization and fine motor control, but long-term follow-up studies have not been reported. We sought to report the long-term outcomes of RHM and compare them to those of LHM.
  
  
  METHODS
  A retrospective cohort study was performed for patients who underwent laparoscopic or RHM between 1995 and 2006. Long-term follow-up was performed via mail or telephone questionnaire. The primary outcome measure was durable relief of dysphagia without need for further intervention. Secondary outcomes included gastroesophageal reflux symptoms, disease-specific quality of life, and patient satisfaction with their operation.
  
  
  RESULTS
  Seventy-five patients underwent laparoscopic (n = 19) or robotic (n = 56) myotomy during the study period. Long-term follow-up was obtained in 53 (71 %) patients with a median interval of 9 years. RHM was associated with a decreased mucosal injury rate (0 vs. 16 %, p = 0.01) and median hospital stay (1 vs. 2 days, p < 0.01) compared to conventional laparoscopy. All patients reported initial dysphagia relief, and 80 % required no further intervention. This did not differ between groups. Sixty-two percent required medications to control reflux symptoms at long-term follow-up, including 56 % following robotic myotomy and 80 % after laparoscopic myotomy (p = 0.27). Overall, 95 % of patients were satisfied with their operation, and 91 % would choose surgery again given the benefit of hindsight.
  
  
  CONCLUSIONS
  There is a dearth of long-term follow-up data to support the effectiveness of RHM. This study demonstrates durable dysphagia relief in the vast majority of patients with a high degree of patient satisfaction and a low rate of esophageal mucosal injury. While a significant proportion of patients report reflux symptoms, these symptoms are well controlled with medical acid suppression.
authors.affiliation: Center for Minimally Invasive Surgery, The Ohio State University Wexner Medical Center, 410 W. 10th Avenue, N729 Doan Hall, Columbus, OH, 43210, USA, Kyle.perry@osumc.edu.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Perry
authors.forename: Aliyah
authors.initials: A
authors.lastname: Kanji
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Drosdeck
authors.forename: John G
authors.initials: JG
authors.lastname: Linn
authors.forename: Anthony
authors.initials: A
authors.lastname: Chan
authors.forename: Peter
authors.initials: P
authors.lastname: Muscarella
authors.forename: W Scott
authors.initials: WS
authors.lastname: Melvin
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000628:therapy; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult