Background and Objective: Quality of life (QOL) is getting more attention in the medical literature. Treatment outcomes are now gauged by their effect on the QOL along with their direct effect on diseases they are targeting. The aim of the study was to assess the impact of residual dysphagia on QOL after Heller myotomy. Methods: QOL was evaluated using the short-form-36 (SF-36) and postoperative dysphagia was assessed using a dysphagia score. The score (range 0-10) 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). Long term follow up (range 12-96 months; average 36 months) was achieved in 60 patients (31 female; mean age 51 years). Myotomy was considered ineffective when the patient's dysphagia score exceeded the 75th percentile. Results: The overall long-term success in relieving dysphagia (responder group) was 78.3%. However, only 5 (8%) were not satisfied with surgery results. Significant differences between the responder and non responder groups were found for most all SF-36 components (Table). Thirty patients reported reflux symptoms. These patients had a significant lower Mental Component Score (MCS) than patients without reflux symptoms (66±22 vs. 80±15, P=0.01). However, patients who underwent Heller plus Dor fundoplication (n=18) did not have higher SF-36 and dysphagia scores than patients who underwent Heller alone. Conclusion: Heller myotomy is a long term effective procedure that improves symptoms and quality of life.
SF-36 Subscale score in the two groups