Journal of Gastrointestinal Surgery

, Volume 23, Issue 1, pp 23–35 | Cite as

A Thousand and One Laparoscopic Heller Myotomies for Esophageal Achalasia: a 25-Year Experience at a Single Tertiary Center

  • Mario Costantini
  • Renato Salvador
  • Giovanni Capovilla
  • Lorenzo Vallese
  • Andrea Costantini
  • Loredana Nicoletti
  • Dario Briscolini
  • Michele Valmasoni
  • Stefano Merigliano
2018 SSAT Plenary Presentation



The aim of this study was to assess the long-term outcome of laparoscopic Heller-Dor (LHD) myotomy to treat achalasia at a single high-volume institution in the past 25 years.


Patients undergoing LHD from 1992 to 2017 were prospectively registered in a dedicated database. Those who had already undergone surgical or endoscopic myotomy were ruled out. Symptoms were collected and scored using a detailed questionnaire; barium swallow, endoscopy, and manometry were performed before and after surgery; and 24-h pH monitoring was done 6 months after LHD.


One thousand one patients underwent LHD (M:F = 536:465), performed by six staff surgeons. The surgical procedure was completed laparoscopically in all but 8 patients (0.8%). At a median of follow-up of 62 months, the outcome was positive in 896 patients (89.5%), and the probability of being cured from symptoms at 20 years exceeded 80%. Among the patients who had previously received other treatments, there were 25/182 failures (13.7%), while the failures in the primary treatment group were 80/819 (9.8%) (p = 0.19). All 105 patients whose LHD failed subsequently underwent endoscopic pneumatic dilations with an overall success rate of 98.4%. At univariate analysis, the manometric pattern (p < 0.001), the presence of a sigmoid megaesophagus (p = 0.03), and chest pain (p < 0.001) were the factors that predicted a poor outcome. At multivariate analysis, all three factors were independently associated with a poor outcome. Post-operative 24-h pH monitoring was abnormal in 55/615 patients (9.1%).


LHD can durably relieve achalasia symptoms in more than 80% of patients. The pre-operative manometric pattern, the presence of a sigmoid esophagus, and chest pain represent the strongest predictors of outcome.


Achalasia Laparoscopic surgery Laparoscopic Heller myotomy Long-term results 



The authors acknowledge all the other surgeons who performed LHD at the Padova University Department of Surgery during the study period: Ermanno Ancona (1992–2012), Mauro Rossi (1992–2001), Giovanni Zaninotto (1995–2007), Christian Rizzetto (2009). Without their work and dedication, this study would not have been possible.

Authors’ Contributions

Study design: Costantini M, Salvador, Briscolini, Merigliano

Data acquisition: Salvador, Vallese, Briscolini, Capovilla, Valmasoni, Nicoletti, Costantini A

Data interpretation: Costantini M, Salvador, Briscolini, Merigliano

Drafting of manuscript: Costantini M, Salvador, Costantini A, Vallese, Briscolini, Valmasoni, Capovilla, Nicoletti, Merigliano

Final approval: Costantini M, Salvador, Vallese, Briscolini, Capovilla, Valmasoni, Costantini A, Nicoletti, Merigliano

Agreement to be accountable for all aspects of the work: Costantini M, Salvador, Vallese, Briscolini, Capovilla, Valmasoni, Costantini A, Nicoletti, Merigliano


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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Mario Costantini
    • 1
  • Renato Salvador
    • 1
  • Giovanni Capovilla
    • 1
  • Lorenzo Vallese
    • 1
  • Andrea Costantini
    • 2
  • Loredana Nicoletti
    • 1
  • Dario Briscolini
    • 1
  • Michele Valmasoni
    • 1
  • Stefano Merigliano
    • 1
  1. 1.Clinica Chirurgica 3, Department of Surgical, Oncological and Gastroenterological SciencesUniversità ed Azienda Ospedaliera di PadovaPaduaItaly
  2. 2.School of MedicineUniversità Cattolica Sacro CuoreRomeItaly

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