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OUTCOMES OF HELLER MYOTOMY SUPPORT IMPROVEMENT IN MENTAL HEALTH AND SOCIAL FUNCTIONING
Bailee Olliff^*, Vic Velanovich
Surgery, University of South Florida, Riverview, FL
Achalasia is a debilitating primary esophageal motility disorder that may have a significant detriment on patient's mental health a social functioning (1). Surgical treatment of achalasia is considered definitive treatment and may be suitable for patients who have tried and failed other modalities (2).
The purpose of this retrospective review was to evaluate outcomes of Heller myotomy including complication and reintervention rates. In addition, we sought to objectively determine changes in quality of life as measured by the Short Form 36 questionnaire after Heller myotomy for achalasia. Between August 2011 and September 2013, data was prospectively collected on patients undergoing Heller myotomy. Inclusion criteria consisted of patients who had a preoperative diagnosis of achalasia, underwent laparoscopic or open Heller myotomy with partial fundoplication, and completed an ASQ (best score 0, worst score 67) and/or a health status assessment using the SF-36 questionnaire (best score in each category 100, worst score 0). We had 22 patients who completed an ASQ as well as an SF-36 before and after surgery; 11 were female and 11 were male. The average age of these patients was 58 years old.
14 of 22 patients had previously undergone intervention for their achalasia, most commonly EGD with dilation. The complication rate among all patients undergoing Heller myotomy was 18%. The reintervention rate was 27% and the most common reintervention was EGD with dilation. The average ASQ prior to surgery was 24.9. This improved to an average of 13.3 after surgery, which is statistically significant (p<0.05). Patients showed a statistically significant improvement in bodily pain, general health, vitality, social functioning, and mental health (all p<0.05). There was no statistically significant improvement in physical functioning, role-physical, or role-emotional categories (Table 1).
Heller myotomy is a safe and often definitive treatment for achalasia. Reintervention with dilation is not uncommon. Patients who underwent Heller Myotomy had statistically significant improvements in their Achalasia Severity Questionnaire (ASQ) as well as the social functioning and mental health portions of their SF-36. Further data collection is needed to validate these results.

References
1. Ben-Meir A, Urbach D R, Khajanchee Y S, Hansen P D, Swanstrom L L. Quality of life before and after laparoscopic Heller myotomy for achalasia. Am J Surg 2001 (May); 181: 471-4.
2. Gockel, Ines, Th Junginger, Gudrun Bernhard, and Volker F. Eckardt. "Heller Myotomy for Failed Pneumatic Dilation in Achalasia." Annals of Surgery 239.3 (2004): 371-77

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