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Outcomes of Laparoscopic Heller Myotomy for Achalasia: 22-Year Experience

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Introduction

Laparoscopic Heller Myotomy is the most effective treatment of achalasia. We examined the durability of symptomatic relief, with and without fundoplication.

Methods

A single institution database between 1995 and 2017 was reviewed. Achalasia symptom severity was assessed by Eckardt scores (ES) obtained at 3-time points via patient questionnaire. Primary outcome was treatment success defined as ES of < 3.

Results

Completed surveys were returned by 130 patients (median follow-up of 6.6 years). A partial fundoplication was performed in 86%. At both 1-year and late follow-up, patients reported a significant improvement in ES compared to baseline (p < 0.05). Of those followed for ≥ 10 years (n = 44), 82% reported ES < 3 at 1-year (p < 0.001), and 78% at last follow-up (p < .001). Of patients who reported treatment success 1-year postoperatively (103/130), 85% continued to report symptomatic relief at last follow-up. Five-year cohort analysis did not show deterioration of dysphagia relief over time. The presence or absence of fundoplication had no impact on long-term outcome (p > 0.05).

Conclusions

LHM provides immediate and durable symptomatic relief, with very few patients requiring further therapeutic intervention. Fundoplication does not appear to influence the durability of symptom relief. Treatment success at 1-year is predictive of long-lasting symptomatic relief.

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Funding

Sundry funds from Dr Rattner that had been developed over several decades from grateful patient gifts were used to pay for the questionaire and other miscellaneous expenses.

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Authors and Affiliations

  1. Division of Gastrointestinal and General Surgery, Massachusetts General Hospital, Boston, MA, USA

    Christina L. Costantino & Abraham D. Geller

  2. Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Michael R. Visenio

  3. Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA, USA

    Christopher R. Morse

  4. Department of Surgery, Division of Gastrointestinal and General Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA

    David W. Rattner

Authors
  1. Christina L. Costantino
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  2. Abraham D. Geller
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  3. Michael R. Visenio
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  4. Christopher R. Morse
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  5. David W. Rattner
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Correspondence to David W. Rattner.

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Costantino, C.L., Geller, A.D., Visenio, M.R. et al. Outcomes of Laparoscopic Heller Myotomy for Achalasia: 22-Year Experience. J Gastrointest Surg 24, 1411–1416 (2020). https://doi.org/10.1007/s11605-020-04586-7

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  • DOI: https://doi.org/10.1007/s11605-020-04586-7

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