Skip to main content
SpringerLink
Log in
Book cover

The SAGES Manual of Foregut Surgery pp 455–471Cite as

Surgical Management of Achalasia: Recurrent Dysphagia

  • Chapter
  • First Online:

  • 1509 Accesses

Abstract

Laparoscopic Heller myotomy with partial fundoplication is the procedure of choice for patients with achalasia. Persistent or recurrent dysphagia can develop over time secondary to several factors primarily related to surgical technique. A systematic and thorough approach is necessary for the diagnostic evaluation of these patients to help determine the most appropriate treatment modality. Endoscopic therapy and revisional surgery are the cornerstones of treatment, and newer endoscopic therapies may provide a more minimally invasive approach to the management of this disease. Esophagectomy remains a surgical option in cases that are refractory to these less invasive treatment therapies. This chapter will focus on the diagnostic and therapeutic approach to patients with persistent or recurrent dysphagia following a Heller myotomy.

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

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Patti MG, et al. Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg. 2003;196(5):698–703; discussion 703–5.

    Article  Google Scholar 

  2. Patti MG, et al. Minimally invasive surgery for achalasia: an 8-year experience with 168 patients. Ann Surg. 1999;230(4):587–93; discussion 593–4.

    Article  CAS  Google Scholar 

  3. Frantzides CT, et al. Minimally invasive surgery for achalasia: a 10-year experience. J Gastrointest Surg. 2004;8(1):18–23.

    Article  Google Scholar 

  4. Wright AS, et al. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007;21(5):713–8.

    Article  CAS  Google Scholar 

  5. Roll GR, et al. Excellent outcomes of laparoscopic esophagomyotomy for achalasia in patients older than 60 years of age. Surg Endosc. 2010;24(10):2562–6.

    Article  Google Scholar 

  6. Sweet MP, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg. 2008;12(1):159–65.

    Article  Google Scholar 

  7. Patti MG, et al. Laparoscopic Heller myotomy and Dor fundoplication for achalasia: analysis of successes and failures. Arch Surg. 2001;136(8):870–7.

    Article  CAS  Google Scholar 

  8. Richards WO, et al. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004;240(3):405–12; discussion 412–5.

    Article  Google Scholar 

  9. Patti MG, Fisichella PM. Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia. How I do it. J Gastrointest Surg. 2008;12(4):764–6.

    Article  Google Scholar 

  10. Patti MG, Herbella FA. Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: what type? J Gastrointest Surg. 2010;14(9):1453–8.

    Article  Google Scholar 

  11. Tatum RP, Pellegrini CA. How I do it: laparoscopic Heller myotomy with Toupet fundoplication for achalasia. J Gastrointest Surg. 2009;13(6):1120–4.

    Article  Google Scholar 

  12. Zaninotto G, et al. Four hundred laparoscopic myotomies for esophageal achalasia: a single centre experience. Ann Surg. 2008;248(6):986–93.

    Article  Google Scholar 

  13. Pellegrini C, et al. Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg. 1992;216(3):291–6; discussion 296–9.

    Article  CAS  Google Scholar 

  14. Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg. 2003;138(5):490–5; discussion 495–7.

    Article  Google Scholar 

  15. Ellis FH Jr, Gibb SP, Crozier RE. Esophagomyotomy for achalasia of the esophagus. Ann Surg. 1980;192(2):157–61.

    Article  Google Scholar 

  16. Smith CD, et al. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy alone. Ann Surg. 2006;243(5):579–84; discussion 584–6.

    Article  Google Scholar 

  17. Snyder CW, et al. Multiple preoperative endoscopic interventions are associated with worse outcomes after laparoscopic Heller myotomy for achalasia. J Gastrointest Surg. 2009;13(12):2095–103.

    Article  Google Scholar 

  18. Patti MG, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci. 1999;44(11):2270–6.

    Article  CAS  Google Scholar 

  19. Bonatti H, et al. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg. 2005;190(6):874–8.

    Article  Google Scholar 

  20. Rakita S, et al. Esophagotomy during laparoscopic Heller myotomy cannot be predicted by preoperative therapies and does not influence long-term outcome. J Gastrointest Surg. 2005;9(2):159–64.

    Article  Google Scholar 

  21. Deb S, et al. Laparoscopic esophageal myotomy for achalasia: factors affecting functional results. Ann Thorac Surg. 2005;80(4):1191–4; discussion 1194–5.

    Article  Google Scholar 

  22. Warner EA, Patti MG, Allaix ME, Pellegrini CA. Revisional surgery for achalasia. In: Fisichella PM, Soper NJ, editors. Surgical management of benign esophageal disorders. London: Springer; 2014. p. 227–40.

    Chapter  Google Scholar 

  23. Petersen RP, Pellegrini CA. Revisional surgery after Heller myotomy for esophageal achalasia. Surg Laparosc Endosc Percutan Tech. 2010;20(5):321–5.

    Article  Google Scholar 

  24. Schuchert MJ, et al. Minimally-invasive esophagomyotomy in 200 consecutive patients: factors influencing postoperative outcomes. Ann Thorac Surg. 2008;85(5):1729–34.

    Article  Google Scholar 

  25. Zaninotto G, et al. Etiology, diagnosis, and treatment of failures after laparoscopic Heller myotomy for achalasia. Ann Surg. 2002;235(2):186–92.

    Article  Google Scholar 

  26. Cowgill SM, et al. Laparoscopic Heller myotomy for achalasia: results after 10 years. Surg Endosc. 2009;23(12):2644–9.

    Article  Google Scholar 

  27. Gockel I, Junginger T, Eckardt VF. Persistent and recurrent achalasia after Heller myotomy: analysis of different patterns and long-term results of reoperation. Arch Surg. 2007;142(11):1093–7.

    Article  Google Scholar 

  28. Campos GM, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249(1):45–57.

    Article  Google Scholar 

  29. Donahue PE, et al. Floppy Dor fundoplication after esophagocardiomyotomy for achalasia. Surgery. 2002;132(4):716–22; discussion 722–3.

    Article  Google Scholar 

  30. Luketich JD, et al. Outcomes after minimally invasive esophagomyotomy. Ann Thorac Surg. 2001;72(6):1909–12; discussion 1912–3.

    Article  CAS  Google Scholar 

  31. Zaninotto G, et al. Long-term outcome and risk of oesophageal cancer after surgery for achalasia. Br J Surg. 2008;95(12):1488–94.

    Article  CAS  Google Scholar 

  32. Patti MG, Diener U, Molena D. Esophageal achalasia: preoperative assessment and postoperative follow-up. J Gastrointest Surg. 2001;5(1):11–2.

    Article  CAS  Google Scholar 

  33. Lopes AB, Fagundes RB. Esophageal squamous cell carcinoma – precursor lesions and early diagnosis. World J Gastrointest Endosc. 2012;4(1):9–16.

    Article  Google Scholar 

  34. Loviscek MF, et al. Recurrent dysphagia after Heller myotomy: is esophagectomy always the answer? J Am Coll Surg. 2013;216(4):736–43. discussion 743-4

    Article  Google Scholar 

  35. Chapman JR, et al. Achalasia treatment: improved outcome of laparoscopic myotomy with operative manometry. Arch Surg. 2004;139(5):508–13; discussion 513.

    Article  Google Scholar 

  36. Moonka R, Pellegrini CA. Malignant pseudoachalasia. Surg Endosc. 1999;13(3):273–5.

    Article  CAS  Google Scholar 

  37. Moonka R, et al. Clinical presentation and evaluation of malignant pseudoachalasia. J Gastrointest Surg. 1999;3(5):456–61.

    Article  CAS  Google Scholar 

  38. Grotenhuis BA, et al. Reoperation for dysphagia after cardiomyotomy for achalasia. Am J Surg. 2007;194(5):678–82.

    Article  Google Scholar 

  39. Iqbal A, et al. Laparoscopic re-operation for failed Heller myotomy. Dis Esophagus. 2006;19(3):193–9.

    Article  CAS  Google Scholar 

  40. Wang L, Li YM. Recurrent achalasia treated with Heller myotomy: a review of the literature. World J Gastroenterol. 2008;14(46):7122–6.

    Article  Google Scholar 

  41. Swanstrom LL, et al. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012;256(4):659–67.

    Article  Google Scholar 

  42. Hungness ES, et al. Comparison of perioperative outcomes between peroral esophageal myotomy (POEM) and laparoscopic Heller myotomy. J Gastrointest Surg. 2013;17(2):228–35.

    Article  Google Scholar 

  43. Hungness ES, et al. Per-oral Endoscopic Myotomy (POEM) after the learning curve: durable long-term results with a low complication rate. Ann Surg. 2016;264(3):508–17.

    Article  Google Scholar 

  44. Pinotti HW, et al. Resection for achalasia of the esophagus. Hepato-Gastroenterology. 1991;38(6):470–3.

    CAS  PubMed  Google Scholar 

  45. Devaney EJ, et al. Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg. 2001;72(3):854–8.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Maryland School of Medicine, Baltimore, MD, USA

    Hope T. Jackson

  2. Department of Surgery, University of Washington, Seattle, WA, USA

    Brant K. Oelschlager

Authors
  1. Hope T. Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brant K. Oelschlager
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Brant K. Oelschlager .

Editor information

Editors and Affiliations

  1. University of Alabama at Birmingham , Birmingham, AL, USA

    Jayleen Grams

  2. The Ohio State University, Columbus, OH, USA

    Kyle A. Perry

  3. Brigham and Women’s Hospital, Boston, MA, USA

    Ali Tavakkoli

Rights and permissions

Reprints and permissions

Copyright information

© 2019 SAGES

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Jackson, H.T., Oelschlager, B.K. (2019). Surgical Management of Achalasia: Recurrent Dysphagia. In: Grams, J., Perry, K., Tavakkoli, A. (eds) The SAGES Manual of Foregut Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-96122-4_39

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-96122-4_39

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96121-7

  • Online ISBN: 978-3-319-96122-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation