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Eur J Cardiothorac Surg 2004;25:1089-1096
© 2004 Elsevier Science NL

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience

Division of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy

Received 20 October 2003; received in revised form 26 January 2004; accepted 28 January 2004.

^* Corresponding author. Address: Policlinico Tor Vergata, Cattedra di Chirurgia Toracica, Università Tor Vergata, Viale Oxford 81, 00133 Rome, Italy. Tel.: +39-6-2090-2884; fax: +39-6-2090-2881
e-mail: mineo{at}med.uniroma2.it

Objective: To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia. Methods: Thirty-nine patients with achalasia (25 males, mean age 42±13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1=no symptoms; 4=persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30±34 mmHg. Six patients had undergone previous pneumatodilation. Results: No procedure related mortality was recorded. Mean follow-up was 107±30 months (54–177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3±8.3 mmHg (P<0.001), in oesophageal width was 11.5±7.1 mm (P<0.001), in dysphagia 1.8±0.8 (P<0.01) and regurgitation 1.4±0.7 (P<0.01). Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement (P<0.001) especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure. Conclusion: Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia.

Key Words: Oesophagus • Achalasia • Oesophagomyotomy • Fundoplication

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