Skip to main content

Results of laparoscopic Heller-Toupet operation for achalasia

Surgical Endoscopy And Other Interventional Techniques volume 18, pages 1565–1571 (2004)Cite this article

Abstract

Background

Laparoscopic myotomy has become the preferred treatment for achalasia. Controversy persists on the need for fundoplication and/or its type; when used, most series have utilized the Dor fundoplication. We report a large series of laparoscopic Heller-Toupet procedures.

Methods

All patients operated for achalasia were entered into a prospective database. Pre and postoperative esophageal symptoms, satisfaction scores, and SF-36 variables were compared. Surgical failures were defined as recurrent or persistent dysphagia leading to secondary treatment. Data are expressed as mean ± S.D.

Results

One hundred consecutive cases were analyzed (61 men, 39 women, age 47 ± 17 yr). Heller-Toupet was performed in 94, whereas six patients had a Dor fundoplication because of mucosal perforation (three) or technical difficulties performing a posterior wrap (three). Operative time was 148 ± 21 min. There were 13 intraoperative adverse events managed laparoscopically, and no conversions. Minor postoperative complications were noted in two cases, whereas there were no major complications or deaths. Mean hospital stay was 1.2 ± 0.5 days, (range 1–4). Follow-up was complete in 92% at 26 ± 17 months. Failures leading to further treatment occurred in 4%. All symptom scores were significantly improved (p < 0.0001). Solid dysphagia score went from 6.4 to 1.0 postoperatively; regurgitation score went from 4.5 to 0.2 (combined frequency and severity, range 0–8). Postoperative global esophageal symptoms scale revealed improvement in 97%, and all domains of the SF-36 were improved.

Conclusions

Although the best surgical approach to achalasia is yet to be determined, laparoscopic Heller-Toupet operation in experienced hands is a safe and effective procedure with low rates of morbidity and failure and high patient satisfaction.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Figure 1
Figure 2
Figure 3
Figure 4

References

  1. R Ackroyd DI Watson PG Devitt GG Jamieson (2001) ArticleTitleLaparoscopic cardiomyotomy and anterior partial fundoplication for achalasia Surg Endosc 15 683–686 Occurrence Handle10.1007/s004640080037 Occurrence Handle11591968

    Article  PubMed  Google Scholar 

  2. A Ben-Meir DR Urbach YS Khajanchee PD Hansen LL Swanstrom (2001) ArticleTitleQuality of life before and after laparoscopic Heller myotomy for achalasia Am J Surg 181 471–474 Occurrence Handle10.1016/S0002-9610(01)00596-7 Occurrence Handle11448446

    Article  PubMed  Google Scholar 

  3. G Decker F Borie D Bouamrirene M Veyrac F Guillon A Fingerhut B Millat (2002) ArticleTitleGastrointestinal quality of life before and after laparoscopic Heller myotomy with partial posterior fundoplication Ann Surg 236 750–758 Occurrence Handle10.1097/00000658-200212000-00007 Occurrence Handle12454513

    Article  PubMed  Google Scholar 

  4. KM Desai ME Klingensmith ER Winslow P Frisella NJ Soper (2002) ArticleTitleSymptomatic outcomes of laparoscopic antireflux surgery in patients eliglble for endoluminal therapies Surg Endosc 16 1669–1673 Occurrence Handle10.1007/s00464-002-8847-1 Occurrence Handle12140637

    Article  PubMed  Google Scholar 

  5. PE Donahue S Horgan KJ Liu JA Madura (2002) ArticleTitleFloppy Dor fundoplication after esophagocardiomyotomy for achalasia Surgery 132 716–723 Occurrence Handle10.1067/msy.2002.128557 Occurrence Handle12407357

    Article  PubMed  Google Scholar 

  6. FH Ellis SuffixJr (1993) ArticleTitleOesophagomyotomy for achalasia: a 22 year experience Br J Surg 80 882–885 Occurrence Handle8369925

    PubMed  Google Scholar 

  7. RJ Finley JC Clifton KC Stewart AJ Graham DF Worsley (2001) ArticleTitleLaparoscopic Heller myotomy improves esophageal emptying and the symptoms of achalasia Arch Surg 136 892–896 Occurrence Handle10.1001/archsurg.136.8.892 Occurrence Handle11485524

    Article  PubMed  Google Scholar 

  8. CT Frantzides RE Moore MA Carlson AK Madan JG Zografakis A Keshavarzian C Smith (2004) ArticleTitleMinimally invasive surgery for achalasia: a 10 year experience J Gastrointest Surg 8 18–23 Occurrence Handle10.1016/j.gassur.2003.09.021 Occurrence Handle14746831

    Article  PubMed  Google Scholar 

  9. BT Heniford BD Matthews KW Kercher R Yavorski SF Greer SL Goldstein SE Deal T Paccico S Drake A Colvin R Cyzner RF Sing (2001) ArticleTitleLaparoscopic anterior esophageal myotomy and toupet fundoplication for achalasia Am Surg 67 1059–1065 Occurrence Handle11730222

    PubMed  Google Scholar 

  10. S Horgan K Hudda T Eubanks (1999) ArticleTitleDoes botulinum toxin injection make esophagomyotomy a more difficult operation? Surg Endosc 13 576–579 Occurrence Handle10.1007/s004649901044 Occurrence Handle10347294

    Article  PubMed  Google Scholar 

  11. JG Hunter TL Trus GD Branum JP Waring (1997) ArticleTitleLaparoscopic Heller myotomy and fundoplication for achalasia Ann Surg 225 655–665 Occurrence Handle10.1097/00000658-199706000-00003 Occurrence Handle9230806

    Article  PubMed  Google Scholar 

  12. N Katkhouda MR Khalil S Manhas S Grant GC Velmahos TW Umbach AM Kaiser (2002) ArticleTitleAndre- Toupet: Surgeon technician par excellence Ann Surg 235 591–599 Occurrence Handle10.1097/00000658-200204000-00019 Occurrence Handle11923617

    Article  PubMed  Google Scholar 

  13. JD Luketich HC Fernando NA Christie PO Buenaventura RJ Keenan S Ikramuddin PR Schauer (2001) ArticleTitleOutcomes after minimally invasive esophagomyotomy Ann Thorac Surg 72 1909–1913 Occurrence Handle10.1016/S0003-4975(01)03127-7 Occurrence Handle11789770

    Article  PubMed  Google Scholar 

  14. RA Malthaner TR Tood L Miller FG Pearson (1994) ArticleTitleLong-term results in surgically managed esophageal achalasia Ann Thorac Surg 58 1343–1346 Occurrence Handle7979656

    PubMed  Google Scholar 

  15. RS McLeod (2001) ArticleTitleQuality of life measurement in the assessment of surgical outcome Adv Surg 33 293–309

    Google Scholar 

  16. BK Oelschlager L Chang CA Pellegrini (2003) ArticleTitleImproved outcomes after extended gastric myotomy for achalasia Arch Surg 138 490–497 Occurrence Handle10.1001/archsurg.138.5.490 Occurrence Handle12742951

    Article  PubMed  Google Scholar 

  17. MG Patti M Arcerito M Pinto ParticleDe CV Feo J Tong W Gantert LW Way (1998) ArticleTitleComparison of thoracoscopic and laparoscopic Heller myotomy for achalasia J Gastrointest Surg 2 561–566 Occurrence Handle10.1016/S1091-255X(98)80057-7 Occurrence Handle10457314

    Article  PubMed  Google Scholar 

  18. MG Patti CV Feo U Diener A Tamburini M Arcerito B Safadi LW Way (1999) ArticleTitleLaparoscopic Heller myotomy relieves dysphagia in achalasia when the esophagus is dilated Surg Endoscl 3 843–847 Occurrence Handle10.1007/s004649901117

    Article  Google Scholar 

  19. MG Patti PM Fisichella S Perretta C Galvani MV Gorodner T Robinson LW Way (2003) ArticleTitleImpact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change J Am Coll Surg 196 698–705 Occurrence Handle10.1016/S1072-7515(02)01837-9 Occurrence Handle12742198

    Article  PubMed  Google Scholar 

  20. MG Patti D Molena PM Fisichella K Whang H Yamada S Perretta LW Way (2001) ArticleTitleLaparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures Arch Surg 136 870–877 Occurrence Handle10.1001/archsurg.136.8.870 Occurrence Handle11485521

    Article  PubMed  Google Scholar 

  21. C Pellegrini LA Wetter R Leichter G Mussan T Mori G Bernstein L Way (1992) ArticleTitleThoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia Ann Surg 216 291–296 Occurrence Handle1417178

    PubMed  Google Scholar 

  22. JH Peters (2001) ArticleTitleAn antireflux procedure is critical to the long-term outcome of esophageal myotomy for achalasia J Gastrointest Surg 5 17–20 Occurrence Handle10.1016/S1091-255X(01)80008-1 Occurrence Handle11370616

    Article  PubMed  Google Scholar 

  23. KW Sharp L Khaitan S Scholz MD Holzman WO Richards (2002) ArticleTitle100 consecutive minimally invasive Heller myotomies: lessons learned Ann Surg 235 631–639 Occurrence Handle10.1097/00000658-200205000-00004 Occurrence Handle11981208

    Article  PubMed  Google Scholar 

  24. S Shimi LK Nathanson A Cuschieri (1991) ArticleTitleLaparoscopic cardiomyotomy for achalasia J R Coll Surg Edinb 36 152–154 Occurrence Handle1833541

    PubMed  Google Scholar 

  25. AE Spiess PJ Kahrilas (1998) ArticleTitleTreating achalasia: from whalebone to laparoscope JAMA 280 638–642 Occurrence Handle10.1001/jama.280.7.638 Occurrence Handle9718057

    Article  PubMed  Google Scholar 

  26. F Raiser G Perdikis RA Hinder LL Swanstrom CJ Filipi PJ McBride N Katada PJ Neary (1996) ArticleTitleHeller myotomy via minimal-access surgery. An evaluation of antireflux procedures Arch Surg 13 593–597

    Google Scholar 

  27. LL Swanstrom J Pennings (1995) ArticleTitleLaparoscopic esophagomyotomy for achalasia Surg Endosc 9 286–90 Occurrence Handle7597600

    PubMed  Google Scholar 

  28. V Velanovich (1998) ArticleTitleComparison of generic (SF-36) vs. disease specific (GERD-HRQL) quality of life scales for gastroesophageal reflux disease J Gastrointest Surg 2 141–145 Occurrence Handle10.1016/S1091-255X(98)80004-8 Occurrence Handle9834409

    Article  PubMed  Google Scholar 

  29. JE Ware KK Snow M Kosinski B Gandek (1993) SF-36 Health survey: manual and interpretation guide The Health Institute, New England Medical Center Boston

    Google Scholar 

  30. G Zaninotto M Costantini D Molena G Portale M Costantino L Nicoletti E Ancona (2001) ArticleTitleMinimally invasive surgery for esophageal achalasia J Laparoendosc Adv Surg Tech 11 351–359 Occurrence Handle10.1089/10926420152761860

    Article  Google Scholar 

Download references

Acknowledgments

The authors gratefully acknowledge the Washington University Institute for Minimally Invasive Surgery for support of this project.

Author information

Affiliations

  1. Washington University Institute for Minimally Invasive Surgery, 660 S Euclid, Box 8109, St. Louis, MO, 63110, USA

    J. M. Perrone, M. M. Frisella & K. M. Desai

  2. Northwestern University Feinberg School of Medicine, Galter 10-105, 201 E. Huron, Chicago, IL, 60611, USA

    N. J. Soper

Authors
  1. J. M. Perrone
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. M. Frisella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. M. Desai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. J. Soper
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N. J. Soper.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Perrone, J.M., Frisella, M.M., Desai, K.M. et al. Results of laparoscopic Heller-Toupet operation for achalasia . Surg Endosc 18, 1565–1571 (2004). https://doi.org/10.1007/s00464-004-8912-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-004-8912-z

Keywords

  • Achalasia
  • Laparoscopy
  • Heller-Toupet operation