Minimally invasive surgery for achalasia

Abstract

BACKGROUND: There are various surgical treatment approaches for achalasia. The outcome of achalasia patients treated with surgery is evaluated. METHODS: From 1994 to 2011, 63 with achalasia were treated by myotomy with or without anti-reflux procedure. The demographics and peri-operative outcomes were analyzed. RESULTS: The median age of the studied population was 37 years (range: 13–67) and 29 (46%) were men. The median duration of symptoms prior to presentation was 18 months (range: 1–36). Prior to surgery, 12 (19%) patients had had non-operative intervention; one patient (1.6%) had botulinum toxin injection and 11 (17.5%) had balloon dilatation. The median number of dilatations was 1 (range: 1–5). Surgical procedures evolved over time; which included thoracoscopic myotomy (n = 9, 14.3%), laparoscopic myotomy (n = 13, 20.6%), laparoscopic myotomy plus Dor hemifundoplication (n = 27, 42.9%), and robotic-assisted laparoscopic myotomy plus Dor hemifundoplication (n = 14, 22.2%). There was no conversion to open surgery. Four patients (6.3%) had esophageal mucosal perforations, all were repaired with no postoperative leak. Pulmonary complication was higher using the thoracoscopic compared to laparoscopic approach, at 33.3% vs. 1.9% (p < 0.01). The duration of follow-up was 25 months (range: 1–150). The mean dysphagia score improved from 3.08 to 1.22 postoperatively. Reflux esophagitis was documented in 9 (40.9%) and 1 (2.4%) patients without and with anti-reflux procedure respectively (p < 0.01). Two patients required balloon dilatation related to persistent dysphagia. DISCUSSION: Minimally invasive surgery for achalasia provides durable and excellent symptoms relief. Anti-reflux procedure significantly reduces postoperative acid reflux.