Abstract
Background
Heller myotomy is accepted as first-line therapy for achalasia, yet for a small number of patients, symptoms persist or recur after myotomy. This study was undertaken to report our results with reoperative laparoscopic Heller myotomy for recurrent symptoms of achalasia.
Methods
We have undertaken laparoscopic Heller myotomy in 275 patients and reoperative myotomy in 12 patients for recurrent dysphagia, of which three had their initial myotomy undertaken by us. For each, studies prior to reoperative Heller myotomy documented a nonrelaxing lower esophageal sphincter without stricture. Patients scored symptoms before and after reoperative myotomy.
Results
Before reoperative myotomy, 75% underwent dilation and 42% underwent Botox injection. Ten of twelve reoperative myotomies were undertaken and completed laparoscopically. Median follow-up is 24.1 months (29.0 months + 25.89). Symptom frequency and severity scores improved significantly after reoperative myotomy. Frequency of vomiting and frequency and severity of heartburn were improved after reoperative myotomy, but not to a significant extent. However, they were not particularly notable prior to surgery, compared to obstructive symptoms, such as dysphagia. Excellent or good outcomes were reported in 73%, and notably, 91% stated that they would have the operation again after having been through the process firsthand and knowing their outcomes.
Conclusion
Patient outcomes promote the application of reoperative Heller myotomy for recurrent or persistent symptoms of achalasia following Heller myotomy.
Similar content being viewed by others
References
Annese V, Basciani M, Lombardi G, Caruso N, Perri F, Simone P, Andriulli A (1996) Perendoscopic injection of botulinum toxin is effective in achalasia after failure of myotomy or pneumatic dilation. Gastrointest Endosc 44: 461–465
Bloomston M, Brady P, Rosemurgy AS (2002) Videoscopic Heller myotomy with intraoperative endoscopy promotes optimal outcomes. JSLS 6: 133–138
Bloomston M, Rosemurgy AS (2002) Selective application of fundoplication during laparoscopic Heller myotomy ensures favorable outcomes. Surg Laparosc Endosc Percutan Tech 12: 309–315
Bloomston M, Serafini F, Boyce HW, Rosemurgy AS (2002) The “learning curve” in videoscopic Heller myotomy. JSLS 6: 41–47
Bloomston M, Serafini F, Rosemurgy AS (2001) Videoscopic Heller myotomy as first-line therapy for severe achalasia. Am Surg 67: 1105–1109
Csendes A, Braghetto I, Burdiles P, Csendes P (1991) Comparison of forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Hepatogastroenterology 38: 502–505
Devaney EJ, Lannettoni MD, Orringer MB, Marshall B (2001) Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg 72: 854–858
Duffy PE, Awad ZT, Filipi CJ (2003) The laparoscopic reoperation of failed Heller myotomy. Surg Endosc 17: 1046–1049
Fishman VM, Parkman HP, Schiano TD, Hills C, Dabezies MA, Cohen S, Fisher RS, Miller LS (1996) Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol 91: 1724–1730
Gorecki PJ, Hinder RA, Libbey JS, Bammer T, Floch N (2002) Redo laparoscopic surgery for achalasia. Surg Endosc 16: 772–776
Guardino JM, Vela MF, Connor JT, Richter JE (2004) Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. J Clin Gastroenterol 38: 855–860
Hsu HS, Wang CY, Hsieh CC, Huang MH (2003) Short-segment colon interposition for end-stage achalasia. Ann Thorac Surg 76: 1706–1710
Mayberry JF (2001) Epidemiology and demographics of achalasia. Gastrointestinal Endosc ClinNorth Am 11: 235–248
Ozawa S, Ando N, Ohgami M, Kitagawa Y, Kitajima M (2000) Laparoscopic surgery for esophageal achalasia. Nippon Geka Gakkai Zasshi. J Jpn Surg Soc 101: 352–356
Patti MG, Pellegrini CA, Horgan S, Arcerito M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW (1999) Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg 230: 587–594
Pechlivanides G, Chrysos E, Athanasakis E, Tsiaoussis J, Vassilakis JS, Xynos E (2001) Laparoscopic Heller cardiomyotomy and Dor fundoplication for esophageal achalasia: possible factors predicting outcome. Arch Surg 136: 1240–1243
Rakita S, Bloomston M, Villadolid D, Thometz D, Zervos E, Rosemurgy A (2005) Esophagotomy during laparoscopic Heller myotomy cannot be predicted by preoperative therapies and does not influence long-term outcome. J Gastrointest Surg 9: 159–164
Richards W, Torquati A, Holzman M, Khaitan L, Byrne D, Lutfi R, Sharp K (2004) Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia. Ann Surg 240: 405–412
Robinson TN, Galvani CA, Dutta SK, Gorodner MV, Patti MG (2003) Laparoscopic treatment of recurrent dysphagia following transthoracic myotomy for achalasia. J Laparoendosc Adv Surg Tech A 13: 401–403
Rosemurgy AS, Arnaoutakis DJ, Thometz DP, Binitie O, Giarelli NB, Bloomston M, Goldin SG, Albrink MH (2004) Reoperative fundoplications are effective treatment for dysphagia and recurrent gastroesophageal reflux. Am Surg 70: 1061–1067
Rosemurgy AS, Villadolid D, Thometz D, Kalipersad C, Rakita S, Albrink M, Johnson M, Boyce W (2005) Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after Botox or dilation. Ann Surg 241: 1–9; discussion 9–11
Sharp KW, Khaitan L, Scholz S, Holzman MD, Richards WO (2002) 100 Consecutive minimally invasive Heller myotomies: lessons learned. Ann Surg 235: 631–633
Vaezi MF, Richter JE, Wilcox CM, Schroeder PL, Birgisson S, Slaughter RL, Koehler RE, Baker ME (1999) Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut 44: 231–239
Zaninotto G, Costantini M, Molena D, Buin F, Carta A, Nicoletti L, Ancona E (2000) Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg 4: 282–289
Zaninotto G, Costantini M, Portale G, Battaglia G, Molena D, Carta A, Costantino M, Nicoletti L, Ancona E (2002) Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann Surg 235: 186–192
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rakita, S., Villadolid, D., Kalipersad, C. et al. Outcomes promote reoperative Heller myotomy for symptoms of achalasia. Surg Endosc 21, 1709–1714 (2007). https://doi.org/10.1007/s00464-007-9226-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9226-8