Factors affecting quality of life after minimally invasive Heller myotomy for achalasia

Yannis Raftopoulos, Rodney J. Landreneau, Fernando Hayetian, Pavlos Papasavas, Keith S. Naunheim, Steven R. Hazelrigg, Ricardo Santos, Daniel Gagné, Philip Caushaj, Robert J. Keenan

Research output: Contribution to journalArticle

20 Scopus citations

Abstract

The effect of prior nonoperative treatment, type of fundoplication, and surgical approach on quality of life after minimally invasive Heller myotomy (MIHM) for achalasia in not known. MIHM for achalasia was performed in 105 patients (primary 102; redo 3). Sixty-five patients had prior nonoperative treatment (dilations in 41; botulinum toxin injections in 13; dilations and botulinum toxin injections in 11). Primary laparoscopic MIHM with fundoplication (Dor in 32; Toupet in 56) was performed in 88 patients and thoracoscopic MIHM without fundoplication in 14. Achalasia and quality-of-life-related symptoms were evaluated prospectively with a visual analogue scoring scale. Median follow-up was 25 months. There was a trend toward a higher incidence of intraoperative esophageal perforation and recurrent dysphagia in patients with prior nonoperative treatment. Patients with prior nonoperative treatment had significant improvement in achalasia-related symptoms postoperatively. Patients with prior botulinum toxin injections with or without dilations had no improvement in quality of life after MIHM. The operative success of MIHM may be compromised if prior nonoperative treatment is used. Botulinum toxin injections may blunt the beneficial effect of MIHM on quality of life. The outcome of MIHM is good regardless of the type of fundoplication or surgical approach.

Original languageEnglish (US)
Pages (from-to)233-239
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume8
Issue number3
DOIs
StatePublished - Mar 1 2004
Externally publishedYes

Keywords

  • Achalasia
  • Heller myotomy
  • Minimally invasive
  • Quality of life

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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    Raftopoulos, Y., Landreneau, R. J., Hayetian, F., Papasavas, P., Naunheim, K. S., Hazelrigg, S. R., Santos, R., Gagné, D., Caushaj, P., & Keenan, R. J. (2004). Factors affecting quality of life after minimally invasive Heller myotomy for achalasia. Journal of Gastrointestinal Surgery, 8(3), 233-239. https://doi.org/10.1016/j.gassur.2003.12.015