Outcomes after minimally invasive esophagomyotomy

Background. Thoracic surgeons traditionally performed thoracotomy and myoto my for achalasia. Recently minimally invasive approaches have been reported with good success. This report summarizes our single-institution experienc e using video-assisted thoracoscopy (VATS) or laparoscopy (LAP) for the tre atment of achalasia. Methods. A review of 62 patients undergoing minimally invasive myotomy for achalasia was performed. There were 27 male and 35 female patients. Mean ag e was 53 years (range 14 to 86). Thirty-seven (59.7%) had failed prior trea tments (balloon dilation, botulinim toxin injection, or prior surgery). Out comes studied were dysphagia score (1 = none, 5 = severe), Short-Form 36 qu ality of life (SF36 QOL) score, and heartburn-related QOL index (HRQOL). Results. Surgery included myotomy and partial fundoplication (5 VATS and 57 LAP). Mortality was zero, and complications occurred in 9 (14.5%) patients . There were 6 perforations (4 repaired by LAP and 2 open). Median length o f stay was 2 days, time to oral intake was 1 day. At a mean of 19 months fo llow-up, 92.5% of patients were satisfied with outcome. Dysphagia scores im proved from 3.6 to 1.5 (p < 0.01) but 3 patients ultimately required esopha gectomy for recurrent dysphagia. HRQOL scores for heartburn and SF-36 QOL s cores were comparable with control populations. Conclusions. Minimally invasive myotomy and partial fundoplication for acha lasia improved dysphagia in 92.5% of patients with heartburn and QOL scores were comparable with normal values at 19-month follow-up. The laparoscopic approach offers excellent results and was the preferred approach by our th oracic group for treating achalasia. Thoracic residency training should str ive to include laparoscopic esophageal experience. (C) 2001 by The Society of Thoracic Surgeons.