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Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: long-term symptomatic follow-up of a prospective randomized controlled trial

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Abstract

Background

Our prior randomized controlled trial of Heller myotomy alone versus Heller plus Dor fundoplication for achalasia from 2000 to 2004 demonstrated comparable postoperative resolution of dysphagia but less gastroesophageal reflux after Heller plus Dor. Patient-reported outcomes are needed to determine whether the findings are sustained long-term.

Methods

We actively engaged participants from the prior randomized cohort, making up to six contact attempts per person using telephone, mail, and electronic messaging. We collected patient-reported measures of dysphagia and gastroesophageal reflux using the Dysphagia Score and the Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) instrument. Patient-reported re-interventions for dysphagia were verified by obtaining longitudinal medical records.

Results

Among living participants, 27/41 (66%) were contacted and all completed the follow-up study at a mean of 11.8 years postoperatively. Median Dysphagia Scores and GERD-HRQL scores were slightly worse for Heller than Heller plus Dor but were not statistically different (6 vs 3, p = 0.08 for dysphagia, 15 vs 13, p = 0.25 for reflux). Five patients in the Heller group and 6 in Heller plus Dor underwent re-intervention for dysphagia with most occurring more than five years postoperatively. One patient in each group underwent redo Heller myotomy and subsequent esophagectomy. Nearly all patients (96%) would undergo operation again.

Conclusions

Long-term patient-reported outcomes after Heller alone and Heller plus Dor for achalasia are comparable, providing support for either procedure.

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Authors and Affiliations

  1. Department of Surgery, Vanderbilt University Medical Center, 1161 Medical Center Drive, D-5203 Medical Center North, Nashville, TN, 37232, USA

    Kristy Kummerow Broman, Sharon E. Phillips, Adil Faqih, Joan Kaiser, Richard A. Pierce, Benjamin K. Poulose, Kenneth W. Sharp & Michael D. Holzman

  2. Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System, Veterans Affairs Medical Center, Nashville, TN, USA

    Kristy Kummerow Broman

  3. Department of Surgery, University of South Alabama Health System, Mobile, AL, USA

    William O. Richards

Authors
  1. Kristy Kummerow Broman
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  2. Sharon E. Phillips
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Correspondence to Kristy Kummerow Broman.

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Discloures

Dr. Kummerow Broman—Salary support from Office of Academic Affiliations (OAA), Department of Veterans Affairs, VA National Quality Scholars Program with use of facilities at VA Tennessee Valley Healthcare System; institutional research support from National Center for Research Resources, Grant UL1RR024975-01, now at the National Center for Advancing Translational Sciences, Grant 2UL1 TR000445-06. Dr. Pierce—Research support from Intuitive Surgical. Dr. Poulose—Salary support from Americas Hernia Society Quality Collaborative, research support from Bard Davol, consultant to Ariste Medical and Pfizer. Ms. Phillips, Mr. Faqih, Mrs. Kaiser, Dr. Richards, Dr. Sharp and Dr. Holzman have no conflicts of interest or financial ties to disclose.

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Kummerow Broman, K., Phillips, S.E., Faqih, A. et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: long-term symptomatic follow-up of a prospective randomized controlled trial. Surg Endosc 32, 1668–1674 (2018). https://doi.org/10.1007/s00464-017-5845-x

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