494 LONG-TERM SYMPTOM CONTROL FOLLOWING LAPAROSCOPIC HELLER MYOTOMY AND DOR FUNDOPLICATION FOR ACHALASIA

Abstract Achalasia is a primary esophageal motility disorder in which there is incomplete relaxation of the lower esophageal sphincter and absence of peristalsis in the lower two-thirds of the esophagus. A favored treatment is with laparoscopic modified Heller myotomy with Dor fundoplication (LHMDor) with over 90% beneficial effect. The short-term outcomes of LHMDor are well documented, but stability and durability of post-operative symptom control over time is less understood. Methods Between 2004–2016, 54 patients with achalasia underwent LHMDor (single center). Using validated questionnaires, patients rated their symptoms in five domains: pain, gastroesophageal reflux disease (GERD), dysphagia, regurgitation and quality of life (QOL), rating their symptoms preoperatively, 4-weeks post-operatively, 6-months post-operatively and yearly following the operation. Results As expected, patients reported marked improvement in dysphagia, odynophagia, regurgitation, GERD and quality of life after the operation (p < 0.001). From then on, the symptom control remained durable with respect to absence of pain, regurgitation and odynophagia; however, we observed a recurrence of GERD symptoms beginning 3–5 years postoperatively (p = 0.001, p = 0.04, respectively), with associated increased antacid use. Following initial LHMDor, 5 patients required endoscopic dilatation an average of 1.5 years post-operatively and no patient required reoperation. Patients reported preserved improved quality of life up to 11 years following the operation (p = 0.001). Conclusion These results demonstrate the durability of LHMDor in the definitive management of achalasia offering consistent symptomatic relief and significant improvement to QOL over the decade following surgery, despite some increase in GERD symptoms and antacid use.