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Outcomes after minimally invasive esophagomyotomy
J D Luketich1, H C Fernando, N A Christie
1University of Pittsburgh Medical Center Health System, Pennsylvania, USA. luketichjd@msx.upmc.edu
The Annals of Thoracic Surgery
|January 16, 2002
Summary
Minimally invasive surgery for achalasia, including laparoscopic myotomy, significantly improved swallowing difficulties in 92.5% of patients. Quality of life scores were comparable to normal values after treatment.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Minimally Invasive Surgery
Background:
- Achalasia treatment traditionally involved thoracotomy and myotomy.
- Minimally invasive techniques like video-assisted thoracoscopy (VATS) and laparoscopy (LAP) have emerged as successful alternatives.
- This study reviews a single institution's experience with VATS/LAP for achalasia.
Purpose of the Study:
- To evaluate the efficacy and outcomes of minimally invasive myotomy for achalasia.
- To assess patient satisfaction, quality of life, and symptom improvement post-procedure.
Main Methods:
- A retrospective review of 62 patients who underwent minimally invasive myotomy for achalasia.
- Patients received either VATS or LAP myotomy with partial fundoplication.
- Outcomes measured included dysphagia scores, SF-36 quality of life (QOL), and heartburn-related QOL (HRQOL).
Main Results:
- Zero mortality and a 14.5% complication rate (including 6 perforations).
- Median hospital stay was 2 days, with oral intake by day 1.
- At 19-month follow-up, 92.5% of patients were satisfied, with significant improvement in dysphagia scores (3.6 to 1.5, p < 0.01).
Conclusions:
- Minimally invasive myotomy and partial fundoplication effectively treat achalasia, improving dysphagia and quality of life.
- The laparoscopic approach demonstrated excellent results and is recommended for achalasia treatment.
- Thoracic surgery training should incorporate laparoscopic esophageal procedures.