Comparison of outcomes following open and laparoscopic esophagomyotomy for achalasia

Background: Minimally invasive esophagomyotomy is replacing open surgery for achalasia, but data comparing these procedures performed by the same surgical team are sparse. The purpose of this study was to compare the morbidity and clinical outcome following laparoscopic and open esophagomyotomy. Methods: Twelve consecutive patients referred for elective surgery between August 1995 and August 1997 underwent laparoscopic myotomy and partial fundoplication. They were compared to a group of 10 patients chosen from a larger pool of 20 patients who had open surgery during the same period performed by our own group. The mean length of follow-up in the laparoscopic group was 16 months; in the open group, it was 60 months. Both groups had similar demographics and clinical features. Each patient had at least one previous pneumatic dilatation. Inpatient records were reviewed. Patients were interviewed using a symptom assessment and patient satisfaction questionnaire. Results: As compared to the open operation, laparoscopic esophagomyotomy with partial fundoplication resulted in significantly (p < 0.05) less blood loss (50 +/- 26 cc versus 220 +/- 127 cc), parenteral narcotic use (2.1 +/- 1.0 days versus 5.3 +/- 1.4 days), time in hospital (2.7 +/- 1.0 days versus 8.8 +/- 2.6 days), and time off work (19 +/- 16 days Versus 85 +/- 60 days). There were similar results for the laparoscopic and open groups in the improvement in dysphagia (92% versus 90%) and patient satisfaction with surgery (84% versus 80%). Conclusions: Laparoscopic esophagomyotomy for achalasia results in symptomatic improvement and high patient satisfaction comparable to the open procedure but with significantly less morbidity.