OBJECTIVE: Laparoscopic myotomy is the preferred treatment of achalasia. Our objectives were to assess the long-term outcome of esophageal myotomy and to identify preoperative factors influencing the outcome. METHODS: Preoperative and long-term outcome data were collected from patients undergoing laparoscopic myotomy for achalasia at our institution. The primary endpoint of the study was the postoperative change (delta) in dysphagia score. This score was calculated by combining the frequency and the severity of dysphagia. Persistent postoperative dysphagia was defined as 1 standard deviation less than the mean delta score of all patients. Logistic regression was used to identify independent preoperative factors associated with successful myotomy. RESULTS: A total of 200 consecutive patients were included in the study. At a mean follow-up of 42.1 months, the mean delta dysphagia score was 7.1 +/- 2.6; therefore, the myotomy was considered successful when the delta score was >4.5. According to this definition, 170 (85%) patients achieved excellent dysphagia relief (responders). Responders had higher preoperative low esophageal sphincter (LES) pressure than nonresponders: 42.6 +/- 13.1 versus 23.8 +/- 7.0 mm Hg (P = 0.001). High preoperative LES pressure remained an independent predictor of excellent response in the multivariate logistic regression model. Patients with LES pressure >35 mm Hg had an odds ratio of 21.3, making more likely to achieve excellent dysphagia relief after myotomy compared with those with LES pressure < or =35 mm Hg (odds ratio, 21.3; 95% confidence interval, 6.1-73.5, P = 0.0001). CONCLUSION: Laparoscopic myotomy can durably relieve symptoms of dysphagia. Elevated preoperative LES pressure represents the strongest positive outcome predictor.
OBJECTIVE: Laparoscopic myotomy is the preferred treatment of achalasia. Our objectives were to assess the long-term outcome of esophageal myotomy and to identify preoperative factors influencing the outcome. METHODS: Preoperative and long-term outcome data were collected from patients undergoing laparoscopic myotomy for achalasia at our institution. The primary endpoint of the study was the postoperative change (delta) in dysphagia score. This score was calculated by combining the frequency and the severity of dysphagia. Persistent postoperative dysphagia was defined as 1 standard deviation less than the mean delta score of all patients. Logistic regression was used to identify independent preoperative factors associated with successful myotomy. RESULTS: A total of 200 consecutive patients were included in the study. At a mean follow-up of 42.1 months, the mean delta dysphagia score was 7.1 +/- 2.6; therefore, the myotomy was considered successful when the delta score was >4.5. According to this definition, 170 (85%) patients achieved excellent dysphagia relief (responders). Responders had higher preoperative low esophageal sphincter (LES) pressure than nonresponders: 42.6 +/- 13.1 versus 23.8 +/- 7.0 mm Hg (P = 0.001). High preoperative LES pressure remained an independent predictor of excellent response in the multivariate logistic regression model. Patients with LES pressure >35 mm Hg had an odds ratio of 21.3, making more likely to achieve excellent dysphagia relief after myotomy compared with those with LES pressure < or =35 mm Hg (odds ratio, 21.3; 95% confidence interval, 6.1-73.5, P = 0.0001). CONCLUSION: Laparoscopic myotomy can durably relieve symptoms of dysphagia. Elevated preoperative LES pressure represents the strongest positive outcome predictor.
Authors: Giovanni Zaninotto; Vito Annese; Mario Costantini; Alberto Del Genio; Michela Costantino; Magdalena Epifani; Giovanni Gatto; Vittorio D'onofrio; Luigi Benini; Sandro Contini; Daniela Molena; Giorgio Battaglia; Berardino Tardio; Angelo Andriulli; Ermanno Ancona Journal: Ann Surg Date: 2004-03 Impact factor: 12.969
Authors: Yannis Raftopoulos; Rodney J Landreneau; Fernando Hayetian; Pavlos Papasavas; Keith S Naunheim; Steven R Hazelrigg; Ricardo Santos; Daniel Gagné; Philip Caushaj; Robert J Keenan Journal: J Gastrointest Surg Date: 2004 Mar-Apr Impact factor: 3.452
Authors: Mustafa A Arain; Jeffrey H Peters; Anan P Tamhankar; Giuseppe Portale; Gideon Almogy; Steven R DeMeester; Peter F Crookes; Jeffrey A Hagen; Cedric G Bremner; Tom R DeMeester Journal: J Gastrointest Surg Date: 2004 Mar-Apr Impact factor: 3.452
Authors: Dimitrios Stefanidis; William Richardson; Timothy M Farrell; Geoffrey P Kohn; Vedra Augenstein; Robert D Fanelli Journal: Surg Endosc Date: 2011-11-02 Impact factor: 4.584