Advertisement

World Journal of Surgery

, Volume 39, Issue 7, pp 1625–1630 | Cite as

Recurrent Symptoms After Heller Myotomy for Achalasia: Evaluation and Treatment

  • Marco G. Patti
  • Marco E. Allaix
Surgical Symposium Contribution

Abstract

A laparoscopic Heller myotomy with partial fundoplication is considered today in most centers in the United States and abroad the treatment of choice for patients with esophageal achalasia. Even though the operation has initially a very high success rate, dysphagia eventually recurs in some patients. In these cases, it is important to perform a careful work-up to identify the cause of the failure and to design a tailored treatment plan by either endoscopic means or revisional surgery. The best results are obtained by a team approach, in Centers where radiologists, gastroenterologists, and surgeons have experience in the diagnosis and treatment of this disease.

Keywords

Achalasia Heller Myotomy Laparoscopic Heller Myotomy Partial Fundoplication Esophageal Achalasia 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors have no conflicts of interest to declare.

References

  1. 1.
    Patti MG, Pellegrini CA, Horgan S et al (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230:587–593PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Patti MG, Molena D, Fisichella PM et al (2001) Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg 136:870–877PubMedCrossRefGoogle Scholar
  3. 3.
    Oelschlager BK, Chang L, Pellegrini CA (2003) Improved outcome after extended gastric myotomy for achalasia. Arch Surg 138:490–495PubMedCrossRefGoogle Scholar
  4. 4.
    Patti MG, Fisichella PM, Perretta S et al (2003) Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg 196:698–703PubMedCrossRefGoogle Scholar
  5. 5.
    Richards WO, Torquati A, Holzman MD et al (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg 240:405–412PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Wright AS, Williams CW, Pellegrini CA et al (2007) Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc 21:713–718PubMedCrossRefGoogle Scholar
  7. 7.
    Sweet MP, Nipomnick I, Gasper WJ et al (2008) The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 12:159–165PubMedCrossRefGoogle Scholar
  8. 8.
    Wang YR, Dempsey DT, Friedenberg FK et al (2008) Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993-2005: effect of surgery volume on perioperative outcomes. Am J Gastroenterol 103:2454–2464PubMedCrossRefGoogle Scholar
  9. 9.
    Patti MG, Fisichella PM (2008) Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia. How I do it. J Gastrointest Surg 12:764–766PubMedCrossRefGoogle Scholar
  10. 10.
    Zaninotto G, Costantini M, Rizzetto C et al (2008) Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg 248:986–993PubMedCrossRefGoogle Scholar
  11. 11.
    Tatum RP, Pellegrini CA (2009) How I do it: laparoscopic Heller myotomy with Toupet fundoplication for achalasia. J Gastrointest Surg 13:1120–1124PubMedCrossRefGoogle Scholar
  12. 12.
    Patti MG, Herbella FA (2010) Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: what type. J Gastrointest Surg 14:1453–1458PubMedCrossRefGoogle Scholar
  13. 13.
    Roll GR, Ma J, Gasper WJ et al (2010) Excellent outcomes of laparoscopic esophagomyotomy for achalasia in patients older than 60 years of age. Surg Endosc 24:2562–2566PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Rawlings A, Soper NJ, Oelschlager B et al (2012) Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial. Surg Endosc 26:18–26PubMedCrossRefGoogle Scholar
  15. 15.
    Pellegrini C, Wetter LA, Patti M et al (1992) Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg 216:291–296PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Csendes A, Braghetto I, Burdiles P et al (2006) Very late results of esophagomyotomy for patients with achalasia. Clinical, endoscopic, histologic, manometric, and acid reflux studies in 67 patients for a mean follow-up of 190 months. Ann Surg 243:196–203PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Zaninotto G, Costantini M, Portale G et al (2002) Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann Surg 235:186–192PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Gockel I, Junginger T, Eckardt VF (2007) Persistent and recurrent achalasia after Heller myotomy: analysis of different patterns and long-term results of reoperation. Arch Surg 142:1093–1097PubMedCrossRefGoogle Scholar
  19. 19.
    Rossetti G, Brusciano L, Amato G et al (2005) A total fundoplication is not an obstacle to esophageal emptying after heller myotomy for achalasia: results of a long-term follow up. Ann Surg 241:614–621PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Zhu ZJ, Chen LQ, Duranceau A (2008) Long-term result of total versus partial fundoplication after esophagomyotomy for primary esophageal motor disorders. World J Surg 32:401–407PubMedCrossRefGoogle Scholar
  21. 21.
    Rebecchi F, Giaccone C, Farinella E et al (2008) Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg 248:1023–1030PubMedCrossRefGoogle Scholar
  22. 22.
    Patti MG, Albanese CT, Holcomb GW 3rd et al (2001) Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia in children. J Pediatr Surg 36:1248–1251PubMedCrossRefGoogle Scholar
  23. 23.
    Patti MG, Feo CV, Arcerito M et al (1999) Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci 44:2270–2276PubMedCrossRefGoogle Scholar
  24. 24.
    Snyder CW, Burton RC, Brown LE et al (2009) Multiple preoperative endoscopic interventions are associated with worse outcomes after laparoscopic Heller myotomy for achalasia. J Gastrointest Surg 13:2095–2103PubMedCrossRefGoogle Scholar
  25. 25.
    Smith CD, Stival A, Howell DL et al (2006) Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy alone. Ann Surg 243:579–584PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Gossage JA, Devitt PG, Watson DI et al (2014) Surveillance endoscopy at 5 or more years after cardiomyotomy for achalasia. Ann Surg 259:464–468PubMedCrossRefGoogle Scholar
  27. 27.
    Loviscek MF, Wright AS, Hinojosa MW et al (2013) Recurrent dysphagia after Heller myotomy: is esophagectomy always the answer? J Am Coll Surg 216:736–744PubMedCrossRefGoogle Scholar
  28. 28.
    Moonka R, Patti MG, Feo CV et al (1999) Clinical presentation and evaluation of malignant pseudoachalasia. J Gastrointest Surg 3:456–461PubMedCrossRefGoogle Scholar
  29. 29.
    Patti MG, Diener U, Molena D (2001) Esophageal achalasia: preoperative assessment and postoperative follow-up. J Gastrointest Surg 5:11–12PubMedCrossRefGoogle Scholar
  30. 30.
    Wang L, Li YM (2008) Recurrent achalasia treated with Heller myotomy: a review of the literature. World J Gastroenterol 14:7122–7126PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Grotenhuis BA, Wijnhoven BP, Myers JC et al (2007) Reoperation for dysphagia after cardiomyotomy for achalasia. Am J Surg 194:678–682PubMedCrossRefGoogle Scholar
  32. 32.
    Iqbal A, Tierney B, Haider M et al (2006) Laparoscopic re-operation for failed Heller myotomy. Dis Esophagus 19:193–199PubMedCrossRefGoogle Scholar
  33. 33.
    Robinson TN, Galvani CA, Dutta SK et al (2003) Laparoscopic treatment of recurrent dysphagia following transthoracic myotomy for achalasia. J Laparoendosc Adv Surg Technol A 13:401–403CrossRefGoogle Scholar
  34. 34.
    Pinotti HW, Cecconello I, da Rocha JM et al (1991) Resection for achalasia of the esophagus. Hepatogastroenterology 38:470–473PubMedGoogle Scholar
  35. 35.
    Devaney EJ, Lannettoni MD, Orringer MB et al (2001) Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg 72:854–858PubMedCrossRefGoogle Scholar
  36. 36.
    Inohue H, Minami H, Kobayashi Y et al (2010) Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy 42:265–271CrossRefGoogle Scholar
  37. 37.
    Swanstrom LL, Kurian A, Dunst CM et al (2012) Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg 256:659–667PubMedCrossRefGoogle Scholar
  38. 38.
    Onimaru M, Inohue H, Ikeda H et al (2013) Peroral endoscopic myotomy is a viable option for failed surgical esophagocardiomyotomy instead of redo surgical Heller myotomy: a single center prospective study. J Am Coll Surg 217:598–605PubMedCrossRefGoogle Scholar
  39. 39.
    Vigneswaran Y, Yetasook AK, Zhao JC et al (2014) Peroral endoscopic myotomy (POEM): feasible as reoperation following Heller myotomy. J Gastrointest Surg 18:1071–1076PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2014

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Chicago Pritzker School of MedicineChicagoUSA
  2. 2.Department of Surgical SciencesUniversity of TorinoTorinoItaly

Personalised recommendations