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Long-Term Results of Laparoscopic Myotomy: Follow-Up Study of Fifty Patients
Barry R. Berch, Vanderbilt University Medical Center, Nashville, TN; Raymond D. Nava, Vanderbilt University School of Medicine, Nashville, TN; Alfonso Torquati, Vanderbilt University Medical Center, Nashville, TN; Kenneth W. Sharp, William O. Richards, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN
Laparoscopic myotomy has become the standard for definitive management of achalasia. However, data regarding the long-term effectiveness of the procedure have been scant. This study was undertaken to assess the long-term results of the procedure. METHODS:Perioperative data were collected prospectively on all patients undergoing laparoscopic myotomy for achalasia, including a structured symptom score questionnaire. The same questionnaire was re-administered by phone to patients with follow-up ≥ 3.75 years. The score was calculated by combining the frequency of dysphagia (0 = never, 1 = <1 day/wk, 2 = 1 day/wk, 3 = 2-3 days/wk, 4 = 4-6 days/wk, 5 = daily) with the severity (0 = none, 1 = very mild, 2 = mild, 3 = moderate, 4 = moderately severe, 5 = severe). The long-term success of myotomy was defined as change (delta) from preoperative dysphagia score >50% and absence of further therapy (repeat myotomy or endoscopic therapy).
RESULTS: According to the follow-up criteria, 50 patients (age = 57 years, 23 females) were successfully contacted. Average follow-up was 6.2 years (range 3.7-10.7 years). The overall cumulative long term success rate, as defined above, was 64% (responders). Forty-two patients (84%) were able to gain or maintain their weight after the procedure. Five patients (10%) required one or more endoscopic dilations after the myotomy. Mean delta dysphagia score was higher in the responder group (7.8±1.9 vs 1.9±2.1, P=0.001). The two groups were similar in terms of age (responder: 57.7±15.9 years; non-responder: 56.4±17.0 years) and gender distribution (responder: 12F, 20M; non-responder: 11F, 7M). The mean length of follow-up was 5.9±1.8 years in the responders and 6.7±2.2 years in the non-responders (P=0.18). Proton pump inhibitors were used by 18 patients (36%) with similar distribution between the two groups (responders: 9/32; non-responders: 9/18, P=0.1). Dor fundoplication was performed in 6 patients (12%) and the outcome comparisons of these patients showed no significant differences. Overall satisfaction was achieved in 94% of contacted patients. CONCLUSIONS: Laparoscopic myotomy is an effective procedure with excellent long-term symptom resolution and overall satisfaction in patients with achalasia.
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