How prior treatment, type of fundoplication, and surgical approach influences quality of life after minimally invasive Heller myotomy for achalasia in not known.
In this study, doctors from the United States assessed 105 patients who underwent minimally invasive Heller myotomy for achalasia.
| Patients who had prior botulinum toxin injections had no improvement in quality of life.|
|Journal of Gastrointestinal Surgery|
Of the 105 patients, 65 had prior nonoperative treatment.
The team performed primary laparoscopic minimally invasive Heller myotomy with fundoplication in 88 of the patients, while 14 underwent thoracoscopic minimally invasive Heller myotomy without fundoplication.
The team used a visual analogue scoring scale to evaluate achalasia and quality-of-life–related symptoms.
Median follow-up was 25 months.
The doctors identified a trend towards a higher incidence of intraoperative esophageal perforation and recurrent dysphagia in patients who had received prior nonoperative treatment.
However, patients who had prior nonoperative treatment had significant improvement in achalasia-related symptoms postoperatively.
Patients who had received prior botulinum toxin injections with or without dilations had no improvement in quality of life after minimally invasive Heller myotomy.
Dr Yannis Raftopoulos's team concluded, "The operative success of minimally invasive Heller myotomy may be compromised if prior nonoperative treatment is used".
"Botulinum toxin injections may blunt the beneficial effect of minimally invasive Heller myotomy on quality of life".
"The outcome of minimally invasive Heller myotomy is good regardless of the type of fundoplication or surgical approach".