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Efficacy and durability of robotic heller myotomy for achalasia: patient symptoms and satisfaction at long-term follow-up

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Abstract

Background

Laparoscopic Heller myotomy (LHM) has become the standard treatment for achalasia in the USA. Robot-assisted Heller myotomy (RHM) has emerged as an alternative approach due to improved visualization and fine motor control, but long-term follow-up studies have not been reported. We sought to report the long-term outcomes of RHM and compare them to those of LHM.

Methods

A retrospective cohort study was performed for patients who underwent laparoscopic or RHM between 1995 and 2006. Long-term follow-up was performed via mail or telephone questionnaire. The primary outcome measure was durable relief of dysphagia without need for further intervention. Secondary outcomes included gastroesophageal reflux symptoms, disease-specific quality of life, and patient satisfaction with their operation.

Results

Seventy-five patients underwent laparoscopic (n = 19) or robotic (n = 56) myotomy during the study period. Long-term follow-up was obtained in 53 (71 %) patients with a median interval of 9 years. RHM was associated with a decreased mucosal injury rate (0 vs. 16 %, p = 0.01) and median hospital stay (1 vs. 2 days, p < 0.01) compared to conventional laparoscopy. All patients reported initial dysphagia relief, and 80 % required no further intervention. This did not differ between groups. Sixty-two percent required medications to control reflux symptoms at long-term follow-up, including 56 % following robotic myotomy and 80 % after laparoscopic myotomy (p = 0.27). Overall, 95 % of patients were satisfied with their operation, and 91 % would choose surgery again given the benefit of hindsight.

Conclusion

There is a dearth of long-term follow-up data to support the effectiveness of RHM. This study demonstrates durable dysphagia relief in the vast majority of patients with a high degree of patient satisfaction and a low rate of esophageal mucosal injury. While a significant proportion of patients report reflux symptoms, these symptoms are well controlled with medical acid suppression.

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Acknowledgments

The authors would like to thank Rebecca Dettorre, MA, CCRC, Research Coordinator for the Center for Minimally Invasive Surgery, for her assistance with this project.

Disclosures

Drs. Perry, Kanji, Drosdeck, Linn, Chan, Muscarella, and Melvin report no biomedical financial interests or potential conflicts of interest relevant to the subject matter of this manuscript.

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Correspondence to Kyle A. Perry.

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Perry, K.A., Kanji, A., Drosdeck, J.M. et al. Efficacy and durability of robotic heller myotomy for achalasia: patient symptoms and satisfaction at long-term follow-up. Surg Endosc 28, 3162–3167 (2014). https://doi.org/10.1007/s00464-014-3576-9

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  • DOI: https://doi.org/10.1007/s00464-014-3576-9

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