Quality of life comparing dor and toupet after heller myotomy for achalasia.
BACKGROUND
Laparoscopic Heller cardiomyotomy (LHC) is standard therapy for achalasia. Traditionally, an antireflux procedure has accompanied the myotomy. This study was undertaken to compare quality-of-life outcomes between patients undergoing myotomy with Toupet versus Dor fundoplication. In addition, we investigated overall patient satisfaction after LHC in the treatment of achalasia.


METHODS
One hundred thirty-five patients who underwent LHC over a 13-year period were identified for inclusion. Symptoms queried included dysphagia, heartburn, and bloating using the Gastroesophageal Reflux Disease-Health-Related Quality of Life Scale and a second published scale for the assessment of gastroesophageal reflux disease and dysphagia symptoms. The patients' overall satisfaction after surgery was also rated. Data were compared on the basis of type of fundoplication. Symptom scores were analyzed using chi-square tests and Fisher's exact tests.


RESULTS
Sixty-three patients completed the survey (47%). There were no perioperative deaths or reoperations. The mean length of stay was 2.8 days. The mean operative time for LHC with Toupet fundoplication was 137.3±30.91 minutes and for LHC with Dor fundoplication was 111.5±32.44 minutes (P=.006). There was no difference with respect to the incidence or severity of postoperative heartburn, dysphagia, or bloating. Overall satisfaction with Toupet fundoplication was 87.5% and with Dor fundoplication was 93.8% (P>.999).


CONCLUSIONS
LHC with either Toupet or Dor fundoplication gave excellent patient satisfaction. Postoperative symptoms of heartburn and dysphagia were equivalent when comparing LHC with either antireflux procedure. Dor and Toupet fundoplication were found to have equivalent outcomes in the short term. We prefer Dor to Toupet fundoplication because of its decreased need for extensive dissection and better mucosal protection.
Department of Surgery, Division of Minimally Invasive/Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Jonathan M
JM
Tomasko
Department of Surgery, Division of Minimally Invasive/Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Toms
T
Augustin
Department of Surgery, Division of Minimally Invasive/Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Tung T
TT
Tran
Department of Surgery, Division of Minimally Invasive/Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Randy S
RS
Haluck
Department of Surgery, Division of Minimally Invasive/Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Ann M
AM
Rogers
Department of Surgery, Division of Minimally Invasive/Bariatric Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Jerome R
JR
Lyn-Sue
D004210:Dissection / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011184:Postoperative Period; D011788:Quality of Life; D016896:Treatment Outcome
Achalasia; Dor fundoplication; Dysphagia; GERD; Heller cardiomyotomy; Toupet fundoplication