Quality of Life After Surgery for End-Stage Achalasia: Pull-Down Heller-Dor Versus Esophagectomy

Abstract Background Therapy for end-stage achalasia is debated: data on long-term functional results of myotomy and esophagectomy are lacking. We compared quality of life and objective outcomes after pulldown Heller-Dor and esophagectomy. Methods The study included 32 patients (57 years, IQR 49-70) who underwent the Heller-Dor operation with verticalisation of the distal esophagus in case of first instance treatment or failed surgery caused by insufficient myotomy and 16 patients (58 years, IQR 49-67) (p=0.806) who underwent esophagectomy after failed surgery for other causes. Data were extracted from a database designed for prospective clinical research. Postoperative dysphagia, reflux symptoms, endoscopic esophagitis were graded by semi-quantitative scales. Quality of life was assessed with the SF-36 questionnaire. Results Median follow-up period was 68 months (IQR 40.43-94.48) after pull-down Heller-Dor and 61 months (IQR 43.72–181.43 months) after esophagectomy (p=0.598). No statistically significant differences were observed with regard to dysphagia (p=0.948), reflux symptoms (p=0.186) or esophagitis (p=0.253). No statistically significant differences were observed in the domains physical functioning (p=0.092), bodily pain (p=0.075) or general health (p=0.453). Significant differences for the domains role physical (100vs100, p=0.043), role emotional (100vs0, p=0.002), vitality (90vs55, p Conclusions The pull-down Heller-Dor achieved objective results similar to those of esophagectomy with a better quality of life. This technique may be the first choice for end-stage achalasia with null or low risk for cancer or after recurrent dysphagia caused by insufficient myotomy.