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Laparoscopic Cardiomyotomy for Achalasia: Clinical Outcomes Beyond 5 Years

Journal of Gastrointestinal Surgery volume 14, pages 594–600 (2010)Cite this article

Abstract

Background

Laparoscopic cardiomyotomy is the most common surgical procedure for the treatment of achalasia, although few reports describe long-term surgical outcomes.

Methods

The outcomes for 155 patients who underwent a laparoscopic cardiomyotomy with anterior partial fundoplication more than 5 years ago (July 1992 to May 2004) were determined. Patients were followed prospectively at yearly time points using a structured questionnaire which evaluated symptoms of dysphagia, reflux, side-effects, and overall satisfaction with the clinical outcome.

Results

Clinical data were available for 125 patients. Thirteen patients died within 5 years of surgery, four were unable to complete the questionnaire, and one developed esophageal squamous cell carcinoma. Nine patients were lost to follow-up, and three would not answer the questionnaire (92.2% late follow-up). Postoperative dysphagia, odynophagia, chest pain, and heartburn was significantly improved at 1 year, 5 years, and late (5+ years) follow-up, with outcomes stable beyond 12 months. Seventy-seven percent of patients reported a good or excellent result (minimal or no symptoms) at 5 years and 73% at late follow-up. At late follow-up, 90% considered they had made the correct decision to undergo surgery.

Conclusions

At minimum 5 years follow-up, laparoscopic cardiomyotomy for achalasia achieves effective and durable relief of symptoms, and most patients are satisfied with the outcome.

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Acknowledgments

The authors are grateful for the contributions of surgeons from the Royal Adelaide Hospital who contributed patients to the database. We are also acknowledge the assistance of Ms. Lorelle Smith, Ms. Nicky Ascott, and Ms. Carolyn Lally who coordinated collection and entry of clinical outcome data into the database.

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Affiliations

  1. Department of Surgery, Flinders University, Flinders Medical Centre, Room 3D211, Bedford Park, SA, 5042, Australia

    Zhen Chen, Justin R. Bessell, Andrew Chew & David Ian Watson

Authors
  1. Zhen Chen
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  2. Justin R. Bessell
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  3. Andrew Chew
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  4. David Ian Watson
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Correspondence to David Ian Watson.

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Chen, Z., Bessell, J.R., Chew, A. et al. Laparoscopic Cardiomyotomy for Achalasia: Clinical Outcomes Beyond 5 Years. J Gastrointest Surg 14, 594–600 (2010). https://doi.org/10.1007/s11605-010-1158-2

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  • DOI: https://doi.org/10.1007/s11605-010-1158-2

Keywords

  • Achalasia
  • Laparoscopy
  • Cardiomyotomy
  • Long-term follow-up
  • Esophagus
  • Dysphagia