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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