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Minimally invasive myotomy for achalasia in the elderly

Arman Kilic1, Matthew J Schuchert, Arjun Pennathur

  • 1Heart, Lung, and Esophageal Surgery Institute, University of Pittsburgh Medical Center, 200 Lothrop St., Suite C-800, Pittsburgh, PA, Pennsylvania, 15261, USA.

Surgical Endoscopy
|November 21, 2007
PubMed
Abstract

Insights

Minimally invasive Heller myotomy (MIM) is a safe and effective treatment for achalasia in elderly patients, offering significant symptom improvement. This procedure should be strongly considered for older individuals with this condition.

Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Geriatric Medicine

Background:

  • Elderly patients with achalasia are increasingly undergoing minimally invasive Heller myotomy (MIM).
  • The risks and outcomes of MIM in this demographic are not fully understood.
  • This study reviews institutional experience with MIM in elderly achalasia patients.

Purpose of the Study:

  • To evaluate the safety and efficacy of minimally invasive Heller myotomy (MIM) in patients aged 70 years and older with achalasia.
  • To define the morbidity and mortality associated with MIM in the elderly population.
  • To compare outcomes of MIM in elderly patients to younger cohorts.

Main Methods:

  • Retrospective analysis of 57 patients (≥70 years) who underwent MIM for achalasia.
  • Procedures were primarily laparoscopic (55) with two videothoracoscopic approaches.
  • Outcomes assessed included postoperative interventions and dysphagia scores (1-5 scale).

Main Results:

  • No perioperative mortality; median hospital stay was 3 days.
  • 19.3% of patients experienced complications, including esophageal perforations and pneumonia.
  • Significant improvement in mean dysphagia score from 3.38 to 1.36 (p < 0.0001), with 96.5% reporting improvement.

Conclusions:

  • Minimally invasive Heller myotomy (MIM) is safe for elderly achalasia patients in experienced centers.
  • MIM provides comparable symptomatic relief in the elderly to younger patients.
  • MIM is a viable therapeutic option for achalasia in older adults.

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