Functional outcome after Heller myotomy and fundoplication for achalasia

This study aims to provide longitudinal prospective data on symptomatic out come following Heller myotomy with fundoplication and to examine variables that might predict a poor outcome. Patients were prospectively followed by means of a biannual mailed questionnaire that assessed symptoms, satisfacti on with the procedure, medication, and need for further intervention. Patie nts were classified as achieving a good or poor outcome based on predetermi ned criteria. Duration of clinical remission was determined using Kaplan-Me ier curves. Between 1992 and 1999, 62 patients with at least 12 months' fol low-up were categorized as having either a good outcome (41 patients) or a poor outcome (21 patients). The cumulative probability of a good outcome at 7 years was 37%. Dysphagia significantly increased over the followup perio d despite initial resolution. Patient variables (age, sex, symptom duration , esophageal dilatation, manometric findings) and operative factors (myotom y length, wrap type, case number, mucosal perforation, primary therapy) wer e not demonstrated to influence outcome at 3 years. A comparison of Nissen fundoplication with partial fundoplication suggested increased dysphagia an d chest pain in the Nissen group. Despite initial symptomatic relief, patie nts with achalasia suffer a progressive decline with recurrent dysphagia an d regurgitation. The type of fundoplication used may contribute to these po or results.