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Laparoscopic Heller Myotomy and Anterior Fundoplication for Achalasia Results in a High Degree of Patient Satisfaction
Mark S. Yamamura, MD;
Jason C. Gilster, MD;
Brian S. Myers, MD;
Clifford W. Deveney, MD;
Brett C. Sheppard, MD
Arch Surg. 2000;135:902-906.
Hypothesis Laparoscopic Heller myotomy with anterior fundoplication will alleviate the symptoms of achalasia and result in excellent patient satisfaction.
Design Retrospective study of consecutive patients who underwent laparoscopic Heller myotomy with anterior fundoplication for achalasia between October 1995 and July 1999. A telephone survey assessed symptoms and satisfaction. Patients were asked to quantitate their symptoms on a scale of 0 to 3 (0 = none; 1, mild; 2, moderate; and 3, severe).
Setting University referral center.
Patients Twenty-four patients who underwent laparoscopic Heller myotomy with anterior fundoplication for achalasia.
Main Outcome Measures Postoperative symptoms and satisfaction.
Results Twenty-one patients (88%) were successfully contacted. Mean follow-up was 16.5 months. The laparoscopic approach was successful in all but 3(88%). The mean dysphagia score was 2.81 preoperatively and 0.81 postoperatively (P<.000). The mean chest pain score was 1.57 preoperatively and 0.86 postoperatively (P<.015). The mean supine regurgitation score was 2.10 preoperatively and 0.57 postoperatively (P<.000). The mean upright regurgitation score was 1.57 preoperatively and 0.52 postoperatively (P<.000). The mean heartburn score was 1.57 preoperatively and 0.57 postoperatively (P<.000). Postoperatively, 18 (86%) of 21 patients could swallow bread without difficulty and 17 (89%) of 19 patients could eat meat without difficulty (2 were excluded as they were vegetarians). Twenty (95%) of 21 patients reported improvement after the operation.
Conclusions Laparoscopic Heller myotomy with anterior fundoplication significantly relieves the symptoms of achalasia without causing the symptoms of gastroesophageal reflux disease. This procedure results in excellent overall patient satisfaction.
From the Department of Surgery, Oregon Health Sciences University, and Veterans Affairs Medical Center, Portland.
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