Current Thoracic Surgery

Background: Endoscopic treatment (ET) methods for achalasia such as balloon dilatation and botulinum toxin injection has good success for short and medium term management of achalasia. However some patients either need repeat attempts or referred to surgery. In this study we analyzed and compared the perioperative and disease specific quality of life outcomes of achalasia patients who either underwent surgery as a first line treatment and the ones who underwent ET method prior to surgery.

Materials and Methods: The patients who underwent standard of care diagnostic workup and surgery for achalasia by the same surgical team between 2007 and 2014 were recorded in a prospective database. The patients who underwent surgery as a first line treatment (Group 1, n = 55) and the patients who underwent prior ET (Group 2, n = 33) were identified. Demographic data, peroperative complications, length of hospital stay, pre- and postoperative Eckardt scores were recorded and analyzed.

Results: A total of 88 patients out of 105 were available for follow up with average follow up time of 61.9 ± 35.8 months. The mean age was 43.3 ± 15.6. Mean hospital stay was 2.3 ± 0.8 days and there was no mortality. Average duration of the effectivity of ET before myotomy was 5.7 ± 7.7 months. Peroperative complications not significantly accumulated in either group. Both groups showed comparable drop in Eckardt scores.

Conclusions: Heller myotomy and Dor fundoplication is a safe and durable option for treatment of achalasia for both treatment naive patients and patients with previous repeated ET modalities.