Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience.
Eur J Cardiothorac Surg
; 25(6): 1089-96, 2004 Jun.
Article
in En
| MEDLINE
| ID: mdl-15145014
ABSTRACT
OBJECTIVE:
To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia.METHODS:
Thirty-nine patients with achalasia (25 males, mean age 42+/-13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1=no symptoms; 4=persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30+/-34 mmHg. Six patients had undergone previous pneumatodilation.RESULTS:
No procedure related mortality was recorded. Mean follow-up was 107+/-30 months (54-177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3+/-8.3 mmHg (P < 0.001) in oesophageal width was 11.5+/-7.1 mm (P < 0.001) in dysphagia 1.8+/-0.8 (P < 0.001) and regurgitation 1.4+/-0.7 (P < 0.001) Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement (P < 0.001) especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure.CONCLUSION:
Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Quality of Life
/
Esophageal Achalasia
Type of study:
Diagnostic_studies
/
Evaluation_studies
/
Observational_studies
/
Prognostic_studies
Aspects:
Patient_preference
Limits:
Adult
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Eur J Cardiothorac Surg
Journal subject:
CARDIOLOGIA
Year:
2004
Document type:
Article
Affiliation country:
Italy