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Copyright of Canadian Journal of Surgery is the property of CMA Impact Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Quality-of-life measurement in controlled clinical trials assessing medical treatment has increased drammatically over the past decades. Although the experience with quality-of-life measurement in surgical clinical trials has been more recent, it has demonstrated the important role of these measures in determining the best treatment options as well as in clinical decisions. Two types of instruments are available to measure quality of life: generic instruments, and specific instruments. Both follow a rigorous scientific methodology that includes both a development and a validation phase. In the validation phase, instruments are assessed for their reproducibility, responsiveness, and validity. Ad hoc instruments, on the other hand, follow no such methodology and results can be open to interpretation. This review demonstrates that quality-of-life measurement in surgical clinical trials is both possible and clinically important. More study investigators will consider measuring quality of life using well-validated instruments when designing future surgical randomized controlled trials. [ABSTRACT FROM AUTHOR]

Achalasia is a primary motor disorder of the esophagus characterized by an abnormal hypertensive, nonrelaxing lower esophageal sphincter (LES) and nonfunctioning, aperistaltic esophageal body resulting in significant regurgitation and dysphagia. The primary goal of treatment is palliation of symptoms. At present, all treatment techniques are directed at relieving the functional obstruction at the level of the LES by disruption or paralysis of the esophageal muscle constituting the LES. Destruction of the LES function also places the patient at risk for pathologic gastroesophageal reflux disease. Therefore, the treatment of patients with achalasia must strike a balance between the relief of dysphagia and potential creation of pathologic gastroesophageal reflux. The advent of laparoscopic esophageal myotomy for the treatment of achalasia over the past decade has resulted in most patients with the disease being referred to surgeons for definitive treatment. At the time of consultation the patient may present with a myriad of symptoms, investigative results, and previous treatments. Based on our experience of over 300 patients treated with surgery at our institution between 1990 and 2007, this review will address the practical problems encountered in the surgical management of achalasia. [ABSTRACT FROM AUTHOR]