2005 Abstracts: LES Pressures Prior to Myotomy Do Not Impact Symptoms Before or After Heller Myotomy or Reductions in Symptoms with Heller Myotomy
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LES Pressures Prior to Myotomy Do Not Impact Symptoms Before or After Heller Myotomy or Reductions in Symptoms with Heller Myotomy
Alexander S. Rosemurgy, Desiree Villadolid, Donald P. Thometz, Steven Rakita, University of South Florida College of Medicine, Tampa, FL
Introduction: It is unknown if preoperative lower esophageal sphincter (LES) pressures impact outcome after laparoscopic Heller myotomy. This study was undertaken to compare LES pressures prior to myotomy with outcome after myotomy.
Methods: 270 patients have undergone laparoscopic Heller myotomy and have been prospectively followed. LES resting pressures were determined in 137 patients before myotomy. Patients scored the frequency and severity of their symptoms before and after myotomy using a Likert scale (0=Never/Not Bothersome to 10=Always/Very Bothersome). Data are presented as median, mean ± SD. Results: Follow-up is 25 months, 32 months ± 28.7. Frequency and severity of symptoms of achalasia improved with myotomy (p<0.001 for all, paired Student's t-test) (Table). Premyotomy LES pressure was 33 mmHg, 34 mmHg ± 14.8. By regression analysis, premyotomy LES pressures did not correlate with the frequencies or severities of any preoperative or postoperative symptoms. As well, there is no significant correlation between premyotomy LES pressures and reductions in symptoms following myotomy. Conclusions: Laparoscopic Heller myotomy palliates symptoms of achalasia. Premyotomy LES pressures were generally high but did not predict the frequency or severity of preoperative or postoperative symptoms of achalasia. As well, the magnitude of symptom reduction with myotomy can not be predicted by premyotomy LES pressures.| Symptom | Before Myotomy | After Myotomy |
| Dysphagia freq. | 10, 9 ± 2.1 | 2, 4 ± 3.2 |
| Dysphagia severity | 10, 8 ± 3.0 | 1, 2 ± 2.5 |
| Chest pain freq. | 6, 5 ± 3.8 | 0, 2 ± 2.5 |
| Chest pain severity | 5, 5 ± 4.0 | 0, 1 ± 2.1 |
| Regurg. freq. | 8, 7 ± 2.8 | 2, 2 ± 2.4 |
| Regurg. severity | 9, 8 ± 3.0 | 0, 2 ± 2.8 |
| Choking freq. | 8, 6 ± 3.7 | 0, 2 ± 2.7 |
| Choking severity | 10, 8 ± 3.2 | 1, 2 ± 2.7 |
| Heartburn freq. | 6, 5 ± 2.4 | 2, 3 ± 4.0 |
| Heartburn severity | 4, 5 ± 3.9 | 1, 2 ± 1.5 |
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