Transthoracic Heller Myotomy for Esophageal Achalasia

Analysis of Long-Term Results

Henning A. Gaissert, Ning Lin, John C. Wain, Grant Fankhauser, Cameron D. Wright, Douglas J. Mathisen

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Swallowing deteriorates over time in some patients after transthoracic esophagomyotomy for achalasia. The causes of decline are poorly understood. Methods: We report a retrospective analysis of transthoracic esophagomyotomy for achalasia. Symptom relief, patient satisfaction, and late intervention were determined during short- and long-term follow-up. Predictors of long-term outcome were identified by logistic regression. Results: From 1962 to 1999, 64 patients underwent transthoracic esophagomyotomy. Five patients had repeat myotomy. Sigmoid esophagus was present in 12 (18%). Fundoplication was absent in 50 patients (myotomy only) and added in 15 (myotomy plus fundoplication). Follow-up was complete in 86% (56 of 65); mean follow-up was 154 months. Thirty-one patients (48%) were followed for more than 10 years. Short-term results were good to excellent in 91% (51 of 56) and long-term in 63% (33 of 52; p < 0.0005). Late peptic stricture occurred in 4 patients (myotomy only, 2 of 38 [5%]; myotomy plus fundoplication, 2 of 14 [14%]). Fewer patients had reflux symptoms after fundoplication (myotomy only, 16 of 38 [42%]; myotomy plus fundoplication, 4 of 14 [29%]), whereas late dysphagia was not reduced (myotomy only, 13 of 38 [34%]; myotomy plus fundoplication, 5 of 14 [36%]). Two patients after myotomy plus fundoplication and 1 after myotomy only had esophagectomy. Early recurrence of symptoms predicted late poor outcome (p < 0.001), whereas sigmoid esophagus, fundoplication, or early postoperative reflux did not. Conclusions: Early good results after esophagomyotomy for achalasia deteriorate over time. Recurring dysphagia early after operation predicts late failure, while sigmoid esophagus does not. Fundoplication reduces reflux symptoms, but not late poor results. These data should be considered in the evaluation of newer, minimally invasive procedures.

Original languageEnglish (US)
Pages (from-to)2044-2049
Number of pages6
JournalAnnals of Thoracic Surgery
Volume81
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

Fingerprint

Fundoplication
Esophageal Achalasia
Sigmoid Colon
Esophagus
Deglutition Disorders
Esophagectomy
Deglutition
Patient Satisfaction
Digestion
Pathologic Constriction
Logistic Models
Recurrence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Transthoracic Heller Myotomy for Esophageal Achalasia : Analysis of Long-Term Results. / Gaissert, Henning A.; Lin, Ning; Wain, John C.; Fankhauser, Grant; Wright, Cameron D.; Mathisen, Douglas J.

In: Annals of Thoracic Surgery, Vol. 81, No. 6, 06.2006, p. 2044-2049.

Research output: Contribution to journalArticle

Gaissert, Henning A. ; Lin, Ning ; Wain, John C. ; Fankhauser, Grant ; Wright, Cameron D. ; Mathisen, Douglas J. / Transthoracic Heller Myotomy for Esophageal Achalasia : Analysis of Long-Term Results. In: Annals of Thoracic Surgery. 2006 ; Vol. 81, No. 6. pp. 2044-2049.
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abstract = "Background: Swallowing deteriorates over time in some patients after transthoracic esophagomyotomy for achalasia. The causes of decline are poorly understood. Methods: We report a retrospective analysis of transthoracic esophagomyotomy for achalasia. Symptom relief, patient satisfaction, and late intervention were determined during short- and long-term follow-up. Predictors of long-term outcome were identified by logistic regression. Results: From 1962 to 1999, 64 patients underwent transthoracic esophagomyotomy. Five patients had repeat myotomy. Sigmoid esophagus was present in 12 (18{\%}). Fundoplication was absent in 50 patients (myotomy only) and added in 15 (myotomy plus fundoplication). Follow-up was complete in 86{\%} (56 of 65); mean follow-up was 154 months. Thirty-one patients (48{\%}) were followed for more than 10 years. Short-term results were good to excellent in 91{\%} (51 of 56) and long-term in 63{\%} (33 of 52; p < 0.0005). Late peptic stricture occurred in 4 patients (myotomy only, 2 of 38 [5{\%}]; myotomy plus fundoplication, 2 of 14 [14{\%}]). Fewer patients had reflux symptoms after fundoplication (myotomy only, 16 of 38 [42{\%}]; myotomy plus fundoplication, 4 of 14 [29{\%}]), whereas late dysphagia was not reduced (myotomy only, 13 of 38 [34{\%}]; myotomy plus fundoplication, 5 of 14 [36{\%}]). Two patients after myotomy plus fundoplication and 1 after myotomy only had esophagectomy. Early recurrence of symptoms predicted late poor outcome (p < 0.001), whereas sigmoid esophagus, fundoplication, or early postoperative reflux did not. Conclusions: Early good results after esophagomyotomy for achalasia deteriorate over time. Recurring dysphagia early after operation predicts late failure, while sigmoid esophagus does not. Fundoplication reduces reflux symptoms, but not late poor results. These data should be considered in the evaluation of newer, minimally invasive procedures.",
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T2 - Analysis of Long-Term Results

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AU - Fankhauser, Grant

AU - Wright, Cameron D.

AU - Mathisen, Douglas J.

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