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Does laparoscopic reoperation yield symptomatic improvements similar to those of primary laparoscopic Heller myotomy in achalasia patients?

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Abstract

Background

Laparoscopic Heller myotomy fails in approximately 3.5% to 15% of patients. Evidence of successful laparoscopic reoperation is limited to a few studies.

Methods

This case–control study was conducted in patients who underwent laparoscopic Heller myotomy reoperation (LHM-R) from 2008 to 2016. The operative outcomes, preoperative and last follow-up manometric parameters, and symptom questionnaire results, including the Eckardt, Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and eating assessment tool (EAT-10) scores, were obtained. The data were compared with those of patients who underwent primary laparoscopic Heller myotomy (LHM-1).

Results

Thirty-five patients who underwent LHM-R and 35 patients who underwent LHM-1 were included. The reasons for failure in the LHM-R patient group included incomplete myotomy (71.4%), myotomy fibrosis (25.7%) and structural alterations in fundoplication (2.9%). The follow-up duration was 34 months for the LHM-R group and 24 months for the LHM-1 group (p = 0.557). The procedure was performed by laparoscopy in 100% of the patients in the two groups. No differences were found regarding surgical morbidity (11.4% LHM-R vs. 2.9% LHM-1, p = 0.164). The symptomatic outcomes were equivalent between groups (Eckardt p = 0.063, EAT–10 p = 0.166, GERD–HRQL p = 0.075). An IRP < 15 mmHg was achieved in 100% of the LHM-R and LHM-1 patients. At the last follow-up, 82.1% of the LHM-R patients and 91.4% of the LHM-1 patients were in symptomatic remission (p = 0.271).

Conclusion

The results achieved with LHM-R are similar to those achieved with LHM-1. Laparoscopic reoperation should be considered an effective and safe treatment after a failed Heller myotomy.

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  1. Oscar Santes and Enrique Coss-Adame contributed equally to this work.

Authors and Affiliations

  1. Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Oscar Santes, Uriel Clemente-Gutiérrez & Gonzalo Torres-Villalobos

  2. Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Enrique Coss-Adame & Miguel A. Valdovinos

  3. Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Janette Furuzawa-Carballeda

  4. Department of Experimental Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico

    Angélica Rodríguez-Garcés, Jose Peralta-Figueroa, Sofia Narvaez-Chavez, Hector Olvera-Prado & Gonzalo Torres-Villalobos

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Oscar Santes, Enrique Coss-Adame, Miguel A. Valdovinos, Janette Furuzawa-Carballeda, Angélica Rodríguez-Garcés, Jose Peralta-Figueroa, Sofia Narvaez-Chavez, Hector Olvera-Prado, Uriel Clemente-Gutiérrez and Gonzalo Torres-Villalobos have no conflicts of interest or financial ties to disclose.

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Santes, O., Coss-Adame, E., Valdovinos, M.A. et al. Does laparoscopic reoperation yield symptomatic improvements similar to those of primary laparoscopic Heller myotomy in achalasia patients?. Surg Endosc 35, 4991–5000 (2021). https://doi.org/10.1007/s00464-020-07978-7

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