title: Dissatisfaction after laparoscopic Heller myotomy: The truth is easy to swallow.
abstract: BACKGROUND
  Although laparoscopic Heller myotomy has been shown to well palliate symptoms of achalasia, we have observed a small subset of patients who are "Dissatisfied". This study was undertaken to identify the causes of their dissatisfaction.
  
  
  METHODS
  Patients undergoing laparoscopic Heller myotomy from 1992 to 2015 were prospectively followed. Using a Likert scale, patients rated their symptom frequency/severity before and after the procedure. Patients graded their experience from "Very Satisfying" to "Very Unsatisfying."
  
  
  RESULTS
  647 patients underwent laparoscopic Heller myotomy. Fifty (8%) patients, median age 57 years and BMI 24 kg/m2reported dissatisfaction at follow-up subsequent to myotomy. "Dissatisfied" patients were more likely to have undergone prior abdominal operations (p = 0.01) or previous myotomies (p = 0.02). "Dissatisfied" patients had a greater incidence of diverticulectomy (p = 0.03) and had longer postoperative LOS (p = 0.01). Symptom frequency/severity persisted after myotomy for dissatisfied patients (p > 0.05).
  
  
  CONCLUSIONS
  Dissatisfaction after laparoscopic Heller myotomy is directly related to persistent/recurrent symptoms. Previous abdominal operations/myotomies, diverticulectomies, and longer LOS are predictors of dissatisfaction. With this understanding, we can identify patients who might be more prone to dissatisfaction.
authors.affiliation: Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, Tampa, FL, USA. Electronic address: arosemurgy@hotmail.com.
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
authors.affiliation: Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, Tampa, FL, USA.
authors.forename: Darrell
authors.initials: D
authors.lastname: Downs
authors.affiliation: Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, Tampa, FL, USA.
authors.forename: Giavanna
authors.initials: G
authors.lastname: Jadick
authors.affiliation: Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, Tampa, FL, USA.
authors.forename: Forat
authors.initials: F
authors.lastname: Swaid
authors.affiliation: Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, Tampa, FL, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.affiliation: Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, Tampa, FL, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Ryan
authors.affiliation: Southeastern Center for Digestive Disorders and Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, Tampa, FL, USA.
authors.forename: Sharona
authors.initials: S
authors.lastname: Ross
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004931:Esophageal Achalasia / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012307:Risk Factors; D016896:Treatment Outcome