Skip to main content
SpringerLink
Log in

Esophagotomy during laparoscopic Heller myotomy cannot be predicted by preoperative therapies and does not influence long-term outcome

  • 2004 SSAT Annual Meeting
  • Published:
Journal of Gastrointestinal Surgery

Abstract

The conventional wisdom is that inadvertent esophagotomy complicates laparoscopic Heller myotomy. This study was undertaken to determine if esophagotomy at myotomy can be predicted by preoperative therapy, and if esophagotomy and/or its repair jeopardizes outcomes. Of 222 laparoscopic Heller myotomies undertaken since 1992, inadvertent esophagotomy occurred in 16 patients (7%); 60 patients who underwent myotomy without esophagotomy were utilized for comparison. Dysphagia and reflux before/ after myotomy were scored by patients on a Likert scale (0-5). The median (mean _ SD) follow-up after myotomy with esophagotomy was 38.8 months (31.6 ± 21.9 months) versus 46.3 months (51.0 ± 21.2 months) after myotomy alone. All esophagotomies were immediately recognized and repaired. Patients who experienced esophagotomy were similar to those who did not in application of Botox (56% vs. 77%) or dilation (44% vs. 65%), years of dysphagia (7.3 ± 5.4 vs. 7.4 ± 6.0), and mean preoperative dysphagia score (4.9 ± 0.4 vs. 4.8 ± 0.4). Esophagotomy led to longer hospitalizations (5.2 days ± 2.5 days vs. 1.5 days ± 0.7 days, P < 0.05) but not different postoperative dysphagia scores (1.5 ± 1.7 vs. 2.1 ± 1.4), reflux scores (1.4 ± 1.7 vs. 2.3 ± 1.3), or good or excellent outcomes (86% vs 84%). Esophagotomy during laparoscopic Heller myotomy is infrequent and cannot be predicted by preoperative therapy or duration or severity of dysphagia. Furthermore, complications after esophagotomy are infrequent and outcomes are indistinguishable from those of patients undergoing uneventful myotomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Heniford BT, Matthews BD, Kercher KW, et al. Laparoscopic anterior esophageal myotomy and Toupet fundoplication for achalasia. Am Surg 2001;67:1059–1067.

    PubMed  CAS  Google Scholar 

  2. Feldman M. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease, 7th ed. Philadelphia:WB Saunders, 2002.

    Google Scholar 

  3. Hirano I. Pathophysiology of achalasia. Curr Gastroenterol Rep 1999;1:198–202.

    Article  PubMed  CAS  Google Scholar 

  4. Bassotti G, Annese V. Pharmacological options in achalasia. Aliment Pharmacol Ther 1999;13:1391–1396.

    Article  PubMed  CAS  Google Scholar 

  5. Gelfond M, Rozen P, Gilat T. Isosorbide dinitrate and nifedipine treatment of achalasia: A clinical manometric and radionuclide evaluation. Gastroenterology 1982;83:963–969.

    PubMed  CAS  Google Scholar 

  6. Bortolotti M, Labo G. Clinical and manometric effects of nifedipine in patients with esophageal achalasia. Gastroenterology 1981;80:39–44.

    PubMed  CAS  Google Scholar 

  7. Pasricha PJ, Ravich WJ, Hendrix TR, Sostre S, Jones B, Kalloo AN. Intrasphincteric botulinum toxin for the treatment of achalasia. N Engl J Med 1995;322:774–778.

    Article  Google Scholar 

  8. Vaezi MF, Richter JE. Current therapies for achalasia: Comparison and efficacy. J Clin Gastroenterol 1998;27:21–35.

    Article  PubMed  CAS  Google Scholar 

  9. Fishman VM, Parkman HP, Schiano TD, et al. Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol 1996; 91:1724–1730.

    PubMed  CAS  Google Scholar 

  10. Vaezi MF, Richter JE, Wilcox CM, et al. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut 1999;44:231–239.

    Article  PubMed  CAS  Google Scholar 

  11. Koshy SS, Nostrant TT. Pathophysiology and endoscopic/ balloon treatment of esophageal motility disorders. Surg Clin North Am 1997;77:971–972.

    Article  PubMed  CAS  Google Scholar 

  12. Csendes A, Braghetto I, Burdiles P, Csendes P. Comparison of forceful dilatation and esophagomyotomy in patients with achalasia of the esophagus. Hepatogastroenterology 1991;38:502–505.

    PubMed  CAS  Google Scholar 

  13. Hunter JG, Trus TL, Branum GD, Waring JP. Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg 1977;225:655–665.

    Article  Google Scholar 

  14. Patti MG, Pellegrini CA, Horgan S, et al. Minimally invasive surgery for achalasia: An 8-year experience with 168 patients. Ann Surg 1999;230:587–594.

    Article  PubMed  CAS  Google Scholar 

  15. PattiMG, Fisichella PM, Perretta S, et al. Impact of minimally invasive surgery on the treatment of esophageal achalasia: A decade of change. J Am Coll Surg 2003;196:698–705.

    Article  PubMed  Google Scholar 

  16. Bloomston M, Boyce W, Mamel J, et al. Videoscopic Heller myotomy for achalasia—Results beyond short-term followup. J Surg Res 2000;92:150–156.

    Article  PubMed  CAS  Google Scholar 

  17. Bloomston M, Serafini F, Rosemurgy AS. Videoscopic Heller myotomy as first-line therapy for severe achalasia. Am Surg 2001;67:1105–1109.

    PubMed  CAS  Google Scholar 

  18. Bloomston M, Brady P, Rosemurgy AS. Videoscopic Heller myotomy with intraoperative endoscopy promotes optimal outcomes. JSLS 2002;6:133–138.

    PubMed  Google Scholar 

  19. Bloomston M, Rosemurgy AS. Selective application of fundoplication during laparoscopic Heller myotomy ensures favorable outcomes. Surg Laparosc Endosc Percutan Tech 2002; 12:309–315.

    Article  PubMed  Google Scholar 

  20. RichardsWO, SharpKW, HolzmanMD. An antireflux procedure should not routinely be added to a Heller myotomy. J Gastrointest Surg 2001;5:13–16.

    Article  PubMed  CAS  Google Scholar 

  21. Bloomston M, Serafini F, Boyce HW, Rosemurgy AS. The "learning curve" in videoscopic Heller myotomy. JSLS 2002; 6:41–47.

    PubMed  Google Scholar 

  22. Hunter J, Richardson W. Surgical management of achalasia. Surg Clin North Am 1997;77:993–1015.

    Article  PubMed  CAS  Google Scholar 

  23. SharpKW, KhaitanL, Scholz S,HfnolzmanMD, RichardsWO.100 consecutive minimally invasive Heller myotomies: Lessons learned. Ann Surg 2002;235:631–639.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of South Florida College of Medicine, Tampa, Florida

    Steven Rakita M.D., Mark Bloomston M.D., Desiree Villadolid B.S., Donald Thometz B.S., Emmanuel Zervos M.D. & Alexander Rosemurgy M.D.

Authors
  1. Steven Rakita M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mark Bloomston M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Desiree Villadolid B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Donald Thometz B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Emmanuel Zervos M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Alexander Rosemurgy M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexander Rosemurgy M.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rakita, S., Bloomston, M., Villadolid, D. et al. Esophagotomy during laparoscopic Heller myotomy cannot be predicted by preoperative therapies and does not influence long-term outcome. J Gastrointest Surg 9, 159–164 (2005). https://doi.org/10.1016/j.gassur.2004.10.015

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1016/j.gassur.2004.10.015

Key Words

Search

Navigation