Subjective and objective assessment of long-term results after Heller-Dor operation for esophageal achalasia.

Aims In this study we assessed how surgery for achalasia modifies in long-term patients’ health related quality of life (HRQL) and we compared the objective and subjective methods of evaluation of results of surgical therapy. Methods 175 patients consecutively submitted to transabdominal Heller myotomy and Dor fundoplication were periodically followed-up with clinical interview, upper GI endoscopy, barium swallow, and manometry. The HRQL was assessed using the 36-item short form (SF-36) and the Psycological General Well Being Index (PGWBI). Spearmann rank correlation coefficient was calculated between result scores of Self-assessment questionnaires and objective assessment of long-term results. Results 175 patients underwent during the years at least one complete clinical-instrumental follow-up; 123 patients filled the self-assessment questionnaires (23 refused to compilate the questionnaire, 12 were reoperated and 7 died during the follow-up). Mean follow-up was 89.3 months (range: 12–296). Long-term results of surgery were excellent or good in 92% of patients, while reflux esophagitis (8%) was the principal cause of failure. In 123/123 patients the SF-36 and PGWBI scores after surgery were better than those found in the general population. Correlations (P < 0.05) were detected in role-physical, in role-emotional and in vitality domains of SF-36, and in anxia, in positive well being and in self-control domains of PGWBI. 6 out of 123 patients that filled the questionnaires with an high HRQL scores had poor long-term results. Conclusions HRQL questionnaires based assessement of result of surgery for achalasia shows a very high satisfaction rate of the patient, in some of them in spite of reflux symptoms or esophagitis.