The laparoscopic reoperation of failed Heller myotomy.
BACKGROUND
Laparoscopic Heller myotomy for achalasia has a 10-20% failure rate and may require reoperation to control persistent, or recurrent symptoms of dysphagia. We report our experience with laparoscopic reoperation for failed Heller myotomy.


METHODS
Between 1996 and 2001, 5 patients underwent reoperative laparoscopic Heller myotomy. The mean age was 39 years. The presenting symptoms were persistent dysphagia ( n = 3), recurrent dysphagia ( n = 1), and weight loss ( n = 1). The mean duration between 1st surgery and recurrence of symptoms was 2 months and the mean duration between surgeries was 27.5 months. All operations were completed laparoscopically.


RESULTS
There were no intraoperative or postoperative complications. Incomplete gastric myotomy was the cause of all 5 primary surgical failures. The mean hospital stay was 2 days. Mean follow-up was 12.8 months. Results were excellent in 2 patients who reported no dysphagia postoperatively (dysphagia grade 0) and good in 3 patients (60%) who all reported improvement in swallowing (dysphagia grade I-II).


CONCLUSIONS
Laparoscopic reoperation for failed Heller myotomy is feasible with encouraging preliminary results.
Duffy
P E
PE
Department of Surgery, Suite 3740, Creighton University Medical Center, 601 North 30th Street, Omaha, NE 68131, USA.
Awad
Z T
ZT
Filipi
C J
CJ
D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods; D004931:Esophageal Achalasia / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure