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J Thorac Cardiovasc Surg 2004;128:402-407
© 2004 The American Association for Thoracic Surgery

General thoracic surgery

Long-term outcome of Heller myotomy in achalasic sigmoid esophagus

^a Division of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy

Received for publication September 28, 2003; revisions received February 3, 2004; accepted for publication February 5, 2004.

^* Address for reprints: Tommaso Claudio Mineo, MD, Cattedra di Chirurgia Toracica, Policlinico Università Tor Vergata, Via Oxford 81, 00133 Rome, Italy
mineo{at}med.uniroma2.it

OBJECTIVE: We sought to assess the long-term outcome of Heller myotomy and anterior fundoplication in patients with achalasic sigmoid esophagus.

METHODS: Fourteen patients with achalasia and sigmoid esophagus (median age, 42.5 years) operated on by the same surgeon through a laparotomy (n = 8) or laparoscopic approach (n = 6) between 1985 and 2000 were evaluated. According to a 4-grade classification (1, no symptoms; 4, persistent symptoms), both dysphagia and regurgitation had a median score of 4.0. Five patients complained of respiratory symptoms. Six patients had undergone previous pneumatic dilation. Preoperative and postoperative workup included an esophagogram, esophagoscopy, manometry, and health-related quality-of-life assessment with the Short-Form 36-item questionnaire.

RESULTS: Median follow-up was 85 months. At 24 months, esophageal width decreased by 10 mm (P = .003), and the change correlated inversely with the age of the patients (R = –0.61; P = .02). Lower esophageal sphincter pressure decreased by 17 mm Hg (P = .001), and both dysphagia and regurgitation scores decreased to 1.0 (P < .003). Comparison with the results of 37 patients with earlier-stage achalasia showed no difference in changes of esophageal width, lower esophageal sphincter pressure, dysphagia score, and regurgitation score. Quality-of-life Short-Form 36-item questionnaire domains, including general health, social functioning, and vitality, improved significantly. Overall results were classified as excellent or good in 10 patients and as satisfactory and unsatisfactory in 2 patients each. No patient required esophagectomy or had esophageal carcinoma.

CONCLUSIONS: In this study Heller myotomy proved effective in improving subjective, objective, and quality-of-life outcome measures in patients with achalasic sigmoid esophagus and should be considered as the first-choice treatment for this severe condition.

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