Skip to main content
SpringerLink
Log in

Postmyotomy recollection of premyotomy symptoms of achalasia is very accurate, supporting longitudinal studies of symptom improvement

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Recollection of preoperative symptom frequency and severity may change postoperatively, thus invalidating longitudinal studies. This study was undertaken to compare symptoms of achalasia before myotomy to patients’ postoperative recollection of premyotomy symptoms.

Methods

A total of 173 patients, 54% male, of median age 48 years, have undergone laparoscopic Heller myotomy and have been followed through a prospectively maintained registry. Preoperatively, patients scored the frequency and severity of their symptoms on a Likert scale: 0 (never/very bothersome) to 10 (always/very bothersome). Similarly, after laparoscopic Heller myotomy, patients scored the frequency and severity of their symptoms, and re-scored their preoperative symptoms. Data are presented as median, mean ± SD.

Results

Before myotomy, dysphagia, regurgitation, choking, chest pain, vomiting, and heartburn were particularly notable; symptom scores nearly globally improved after myotomy (p < 0.05 for all, Wilcoxon matched pairs test), especially obstructive symptoms. Postmyotomy recollection of premyotomy symptom frequency and severity was neither substantively nor consistently different from premyotomy scoring.

Conclusions

Before myotomy, patient symptom scores reflected the deleterious impact of achalasia. After myotomy, patient symptom scores dramatically improved, reflecting the favorable impact of laparoscopic Heller myotomy. Even years after myotomy, patient recollection of premyotomy symptom severity and frequency is very accurate and supports longitudinal studies of symptom improvement after myotomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.

Similar content being viewed by others

References

  1. Bansal R, Nostrant TT, Scheiman JM, Koshy S, Barnett JL, Elta GH, Chey WD (2003) Intersphincteric botulinum toxin versus pneumatic balloon dilation for treatment of primary achalasia. J Clin Gastroenterol 36:209–214

    Article  CAS  PubMed  Google Scholar 

  2. Bloomston M, Serafini F, Rosemurgy AS (2001) Videoscopic Heller myotomy as first-line therapy for severe achalasia. Am Surg 67:1105–1109

    CAS  PubMed  Google Scholar 

  3. Bloomston M, Brady P, Rosemurgy AS (2002) Videoscopic Heller myotomy with intraoperative endoscopy promotes optimal outcomes. JSLS 6:133–138

    PubMed  Google Scholar 

  4. Bloomston M, Rosemurgy AS (2002) Selective application of fundoplication during laparoscopic Heller myotomy ensures favorable outcomes. Surg Laparosc Endosc Percutan Tech 12:309–315

    Article  PubMed  Google Scholar 

  5. Bonatti H, Hinder RA, Klocker J, Neuhauser B, Klaus A, Achem SR, de Vault K (2005) Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg 190:874–878

    Article  PubMed  Google Scholar 

  6. Culliere C, Ducrotte P, Zerbib F,Metman de Looze D, Guilletmot F, Hudziak H, Lamouliatte H, Grimaud JC, Robert A, Dapoigny M, Bost R, Lemann M, Bigard MA, Denis P, Auget JL, Galmiche JP, Bruley des Varannes S (1997) Achalasia: outcome of patients treated with intrasphincteric injection of botulinum toxin. Gut 41: 87–92

    Article  Google Scholar 

  7. Goldblum JR, Whyte RI, Orringer MB, Appelman HD (1994) Achalasia: a morphologic study of 42 resected specimens. Am J Surg Pathol 18: 327–337

    Article  CAS  PubMed  Google Scholar 

  8. Heller E (1914) Extramukose kerkioplastic beim chronischen Kardiospasmus mit Dilatation des Oesophagus. Mitt Grenzgeb Med Chir 27: 141–149

    Google Scholar 

  9. Herrmann D (1995) Reporting current, past, and changed health status: what we know about distortion. Med Care 33: AS89–AS94S

    CAS  PubMed  Google Scholar 

  10. Mayberry JF (2001) Epidemiology and demographics of achalasia. Gastrointest Endosc Clin North Am 11: 235–248

    CAS  Google Scholar 

  11. Patti MG, Pelligrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW (1999). Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230: 587–594

    Article  CAS  PubMed  Google Scholar 

  12. Payne WS (1989) Heller’s contribution to the surgical treatment of achalasia of the esophagus. Ann Thoracic Surg 48: 876

    Article  CAS  Google Scholar 

  13. Raftopoulos Y, Landreneau RJ, Hayetian F, Papasavas P, Naunheim KS, Hazelrigg SR, Santos R, Gagne D, Caushaj P, Keenan RJ (2004) Factors affecting quality of life after minimally invasive Heller myotomy for achalasia. J Gastrointest Surg 8: 233–239

    Article  PubMed  Google Scholar 

  14. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240: 405–415

    Article  PubMed  Google Scholar 

  15. Rosemurgy A, Villadolid D, Thometz D, Kalipersad C, Rakita S, Albrink M, Johnson M, Boyce W (2005) Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after botox or dilation. Ann Surg 241: 725–733

    Article  PubMed  Google Scholar 

  16. Sharp KW, Khaitan L, Scholz S, Holzman MD, Richards WO (2002) 100 consecutive minimally invasive Heller myotomies: lessons learned. Ann Surg 235: 631–639

    Article  PubMed  Google Scholar 

  17. Vaezi MF, Richter JE (1998) Current therapies for achalasia. J Clin Gastroenterol 27: 21–35

    Article  CAS  PubMed  Google Scholar 

  18. West RL, Hirsch DP, Bartelsman JF, de Borst J, Ferwerda G, Tytgat GN, Boeckxtaens GE (2002) Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol 97: 1346–1351

    Article  CAS  PubMed  Google Scholar 

  19. Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, Gatto G, D’Onofrio V, Benini L, Contini S, Molena D, Battaglia G, Tardio B, Andriulli A, Ancona E (2004) Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg 239: 364–370

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Digestive Disorders Center, Tampa General Hospital, and Department of Surgery, University of South Florida College of Medicine, P.O. Box 1289, Rm F145, Tampa, Florida, 33601, USA

    S. M. Cowgill, D. Villalodid, S. Al-Saadi, J. Hedgecock & A. S. Rosemurgy

Authors
  1. S. M. Cowgill
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Villalodid
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Al-Saadi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Hedgecock
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. S. Rosemurgy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. S. Rosemurgy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cowgill, S.M., Villalodid, D., Al-Saadi, S. et al. Postmyotomy recollection of premyotomy symptoms of achalasia is very accurate, supporting longitudinal studies of symptom improvement. Surg Endosc 21, 2183–2186 (2007). https://doi.org/10.1007/s00464-007-9332-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-007-9332-7

Keywords

Search

Navigation