Chest pain before and after laparoscopic cardiomyotomy for achalasia

Abstract

Laparoscopic cardiomyotomy usually achieves a good outcome for patients with achalasia. However, some patients continue to experience chest pain after surgery, even when symptoms such as dysphagia have resolved. In this study, we quantified chest pain and the impact of myotomy on this symptom. In 108 patients who underwent laparoscopic cardiomyotomy, chest pain was assessed before and after surgery. A standardized questionnaire evaluated chest pain, other symptoms including odynophagia, dysphagia and regurgitation, and overall satisfaction with the outcome of surgery. The proportion of patients reporting chest pain was similar across all age groups and genders before and after surgery. Sixty-five (60.2%) patients reported some chest pain after surgery. Of these, 47 (72.3%) also reported dysphagia, 9 (13.8%) odynophagia and 23 (35.4%) acid regurgitation (62.3%, 11.6% and 21.7% before surgery). Following surgery, there was a significant reduction in the frequency of chest pain (daily chest pain declined from 26.9% to 5.6%). Chest pain is common before and after cardiomyotomy for achalasia, and it is frequently associated with dysphagia. Whilst it is less problematic after surgery, it persists in many patients. This information should be provided to individuals considering surgery for achalasia.