Objective: Laparoscopic cardiomyotomy is an effective treatment for the symptoms of achalasia. However, no studies have evaluated how improvements in symptoms correlate to the results of esophageal function tests. The aim of this study was to compare patient's subjective outcomes to the results of postoperative esophageal function tests after laparoscopic treatment of achalasia.
Methods: This was a review of a prospectively maintained database of patients who had a laparoscopic Heller myotomy with Toupet fundoplication for achalasia at a tertiary referral center. Data included pre- and post-operative assessment of quality of life, patient symptoms, esophageal manometry, and 24-hr pH studies.
Results: Complete quality of life and objective outcome data were available for 17 of 42 patients who had surgery between 1993 and 2000. At 6-month follow-up, all patients had improvement in solid and liquid dysphagia, health-related quality of life by SF-36 scoring, and manometric LES pressure and function. Eight patients had mild residual dysphagia (5 to solids, 3 to solids and liquids). There was no correlation between the presence of postoperative dysphagia and postoperative LES pressure, percent relaxation, or esophageal peristalsis. At 6-month follow-up, nine patients complained of gastroesophageal reflux symptoms (GERD) requiring medical treatment, but had normal DeMeester scores (nl<14.7). Only one patient had GERD and an elevated DeMeester score of 102. Three patients had a pathologic DeMeester score (27,15,17) at 6-month follow-up, but were asymptomatic. At two-year follow-up, two of these three patients had developed significant GERD. Six patients had a post-operative improvement in esophageal peristalsis. The mean±SEM duration of achalasia symptoms before surgery for this group was 2.6±1.1 years compared to 5.5±1.7 years for patients with no post-operative improvement in esophageal peristalsis.
Conclusion: Laparoscopic Heller myotomy with Toupet fundoplication is most effective for patients with a short duration of sypmtoms. There is a poor correlation between patient symptoms and post-operative esophageal function, stressing the need for objective follow-up.