Four Hundred Laparoscopic Myotomies for Esophageal Achalasia

• DOI: 10.1097/sla.0b013e3181907bdd
• Publication Date: 2008-12-17T08:14:34Z
• Authors: Giovanni Zaninotto; Mario Costantini; Christian Rizzetto; Lisa Zanatta; Emanuela Guirroli; Giuseppe Portale; Loredana Nicoletti; Francesco Cavallin; Giorgio Battaglia; Alberto Ruol; Ermanno Ancona
• Keywords: Esophageal disease; Heller myotomy

In Brief Objective: Laparoscopic myotomy is the currently preferred treatment for achalasia. Our objectives were to assess long-term outcome of this operation and preoperative factors influencing said outcome. Methods: Demographic clinical characteristics data on prospectively collected patients undergoing laparoscopic achalasia at our institution from 1992 2007. Treatment failure was defined as a postoperative symptom score higher than 10th percentile (>9). Logistic regression analysis used identify independent associated with successful myotomy. Results: Four hundred seven consecutive (220 men, 187 women) underwent Heller-Dor procedure during study period; 89 (22%) them had previously endoscopic treatment(s). The mortality rate 0; conversion morbidity rates 1.5% 1.9%, respectively. failed in 10% (39/407) 5-year actuarial probability being asymptomatic 87%. Most failures (25/39, 64%) occurred within 12 months can be considered technical (incomplete myotomy). Pneumatic dilation overcome dysphagia 75% whose surgery unsuccessful. Considering both primary ancillary treatment, effective 97% patients. frequency sigmoid esophagus, lower esophageal sphincter (LES) resting pressures, chest pain scores differed statistically between without recurrences. At multivariate analysis, high LES pressures (>30 mm Hg) an predictor good response. presence esophagus independently predicted procedure. Conclusion: durably relieve symptoms. High represent strongest positive outcome, probably reflecting less severely damaged muscle.