Journal of Gastrointestinal Surgery

, Volume 12, Issue 1, pp 159–165

The Outcome of Laparoscopic Heller Myotomy for Achalasia is Not Influenced by the Degree of Esophageal Dilatation

  • Matthew P. Sweet
  • Ian Nipomnick
  • Warren J. Gasper
  • Karen Bagatelos
  • James W. Ostroff
  • Piero M. Fisichella
  • Lawrence W. Way
  • Marco G. Patti
Article

Abstract

In the past, a Heller myotomy was considered to be ineffective in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus. Esophagectomy was the standard treatment. The aims of this study were (a) to evaluate the results of laparoscopic Heller myotomy and Dor fundoplication in patients with achalasia and various degrees of esophageal dilatation; and (b) to assess the role of endoscopic dilatation in patients with postoperative dysphagia. One hundred and thirteen patients with esophageal achalasia were separated into four groups based on the maximal diameter of the esophageal lumen and the shape of the esophagus: group A, diameter <4.0 cm, 46 patients; group B, esophageal diameter 4.0–6.0 cm, 32 patients; group C, diameter >6.0 cm and straight axis, 23 patients; and group D, diameter >6.0 cm and sigmoid-shaped esophagus, 12 patients. All had a laparoscopic Heller myotomy and Dor fundoplication. The median length of follow-up was 45 months (range 7 months to 12.5 years). The postoperative recovery was similar among the four groups. Twenty-three patients (20%) had postoperative dilatations for dysphagia, and five patients (4%) required a second myotomy. Excellent or good results were obtained in 89% of group A and 91% of groups B, C, and D. None required an esophagectomy to maintain clinically adequate swallowing. These data show that (a) a laparoscopic Heller myotomy relieved dysphagia in most patients with achalasia, even when the esophagus was dilated; (b) about 20% of patients required additional treatment; (c) in the end, swallowing was good in 90%.

Keywords

Esophageal achalasia Esophageal manometry Botulinum toxin Pneumatic dilatation Laparoscopic Heller myotomy Esophagectomy 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Matthew P. Sweet
    • 1
  • Ian Nipomnick
    • 1
  • Warren J. Gasper
    • 1
  • Karen Bagatelos
    • 2
  • James W. Ostroff
    • 2
  • Piero M. Fisichella
    • 1
  • Lawrence W. Way
    • 1
  • Marco G. Patti
    • 1
    • 3
  1. 1.Department of SurgeryUniversity of California San FranciscoSan FranciscoUSA
  2. 2.Department of MedicineUniversity of California San FranciscoSan FranciscoUSA
  3. 3.Department of SurgeryUniversity of California San FranciscoSan FranciscoUSA

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