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Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy

  • 2019 SAGES Oral
  • Published:
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Abstract

Background

Achalasia is an uncommon disease treated by decreasing the lower esophageal sphincter resting pressure. This study compared the safety and efficacy of esophago-gastric myotomy via laparoscopic, robotic, and per-oral endoscopic approaches.

Methods

A retrospective review of data on patients with achalasia or other esophageal dysmotility disorder undergoing laparoscopic, robotically assisted, or per-oral endoscopic myotomy (POEM) procedures between 2013 and 2017 was performed. Patient demographics, comorbidities, procedure details, length of stay, 30-day readmission rate, and combined technical complication (full-thickness injury, conversion to open, and delayed perforation) were compared. Multiple logistic regression analysis was performed to determine which factors contributed to combined technical complication.

Results

There were 171 patients who underwent esophago-gastric myotomy with 161 (94.2%) having achalasia. There were 40 laparoscopic Heller myotomies with partial fundoplication, 44 robotic Heller myotomies with partial fundoplication, and 87 POEM procedures performed during the study period. Baseline statistical differences were found among the groups in regard to gastroesophageal reflux symptoms, arrhythmia, hypertension, and congestive heart failure. Laparoscopic Heller myotomy had significantly higher combined technical complications (7, 17.5%) compared to robotically assisted Heller myotomy (0, 0%) and POEM (1, 1.1%). Multivariate analysis showed that laparoscopic Heller myotomy (OR 32.22; 95% CI 2.66, 389.83; p = 0.01), myocardial infarction (OR 27.94; 95% CI 1.66, 471.10; p = 0.02), and history of smoking (OR 8.87; 95% CI 1.29, 61.15; p = 0.03) were risks for developing combined technical complications.

Conclusion

Robotically assisted Heller myotomy and POEM are safe and efficacious treatments for achalasia with lower rates of technical complications compared to laparoscopic Heller myotomy. With the advancements in endoscopic instruments and robotic surgery, POEM and robotically assisted Heller myotomy should be considered in the treatment of achalasia and esophageal dysmotility disorders.

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Authors and Affiliations

  1. Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA

    Aman B. Ali, Najah A. Khan, Ray Chihara, Edward Y.  Chan & Min P. Kim

  2. Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA

    Edward Y.  Chan, Brian J. Dunkin & Min P. Kim

  3. Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA

    Duc T. Nguyen & Edward A. Graviss

Authors
  1. Aman B. Ali
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  2. Najah A. Khan
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  3. Duc T. Nguyen
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  4. Ray Chihara
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  5. Edward Y.  Chan
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  6. Edward A. Graviss
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  7. Brian J. Dunkin
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  8. Min P. Kim
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Corresponding author

Correspondence to Min P. Kim.

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Disclosures

Dr. Chan reports financial activities outside the submitted work from Olympus, Boston Scientific, Ethicon, and Veran. Dr. Kim reports financial activities outside the submitted work from Olympus, Boston Scientific, Medtronic, Veran, and Intuitive Surgical. Dr. Dunkin reports financial activity outside the submitted work for Olympus, Boston Scientific, Pacira, Medtronic, Ethicon, and SurgWise. Drs. Ali, Nguyen, Chihara, and Graviss as well as Ms. Khan have no conflicts of interest or financial ties to disclose.

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Ali, A.B., Khan, N.A., Nguyen, D.T. et al. Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy. Surg Endosc 34, 3191–3196 (2020). https://doi.org/10.1007/s00464-019-07093-2

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  • DOI: https://doi.org/10.1007/s00464-019-07093-2

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