Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia

Background: Treatment options for achalasia include medications, endoscopic balloon dilation, injection of botulinum toxin, or surgery. Methods: The clinical course of 75 consecutive patients who underwent minimally invasive Heller myotomy and partial fundoplication for achalasia between 1991 and 2001 was reviewed by means of a questionnaire. Results: Mean follow-up was 5.3 (range.8 to 10.9) years. Sixty-four percent of questionnaires were returned. Thirty-seven patients (84%) felt much better and 6 (14%) slightly better; 1 (2%) rated the result as unchanged. Twenty-six patients (59%) experienced weight gain. Seven patients (16%) had persistent swallowing problems and 5 (11%) reported frequent reflux. Twenty-five percent underwent additional therapy, including dilation (n = 8, 18%), repeat surgery (n = 2, 5%), and botulinum toxin injection (n = 2, 5%). Eighteen patients (41%) were using a proton pump inhibitor or H2 blocker, three were on a calcium channel blocker (7%), and I was using nitroglycerine (2%). Conclusion: Laparoscopic Heller myotomy can achieve short- and long-term results comparable to open surgery and should be considered the treatment of choice to for patients suffering from achalasia. Despite the frequent need for further therapy, patient satisfaction is good. (c) 2005 Excerpta Medica Inc. All rights reserved.