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Prospective studies comparing laparoscopic to open Heller myotomy for esophageal achalasia are lacking. The aim of this study was to compare functional outcome after laparoscopic and open Heller myotomy for esophageal achalasia.Eighty-two patients who underwent Heller-Dor myotomy for achalasia, via laparoscopy (n = 52) or open surgery (n = 30) were recorded prospectively (1993–2002). Median follow-up was 51 (12–111) months. Perioperative functional data were assessed via dysphagia and overall clinical (dysphagia, chest pain, regurgitation, gastroesophageal reflux) scores.In laparoscopy patients, the operative time was longer (145 [95–290] vs 120 [70–230] minutes, P < .0001); the postoperative hospital stay and feeding resumption time was shorter (4 [2–25] vs 7.5 [5–18] days, P < .0001 and 2 [1–15] vs 4 [1–14] days, P < .0001). Three mucosal tears necessitated conversion to open surgery (6%). The rates of “excellent” or “satisfactory” results after laparoscopic and open surgery were 92% (n = 48/52) versus 93% (n = 28/30), and 83% (n = 43/52) versus 83% (n = 25/30) on overall clinical score. In both groups, the overall clinical score indicated significant improvement during 12-month follow-up. The laparoscopy and open surgery symptomatic gastroesophageal reflux rates were 10% and 7%, respectively.Laparoscopic Heller myotomy favorably compares with open surgery regarding dysphagia relief and gastroesophageal reflux rate. Overall clinical score indicates gradual improvement in patient functional status during 12-month follow-up.