Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after botox or dilation.
OBJECTIVE
To report outcome after laparoscopic Heller myotomy in a large number of patients.


BACKGROUND
Laparoscopic Heller myotomy has been undertaken for over a decade, but most studies involve small numbers of patients with limited follow-up.


METHODS
Since 1992, 262 patients have undergone laparoscopic Heller myotomy and been prospectively followed. Concomitant fundoplication was undertaken for a patulous hiatus or large hiatal hernia or to buttress the repair of an esophagotomy until recently when it became routinely applied. With mean follow-up at 32 months, symptoms were scored by patients on a Likert scale (frequency: 0 = Never to 10 = Every time I eat/always; severity: 0 = Not bothersome to 10 = Very bothersome).


RESULTS
Before myotomy, 79% received Botox or bag dilation: 52% had Botox, 59% underwent dilation, and 36% had both. Inadvertent esophagotomy occurred in 5%. Concomitant diverticulectomy was undertaken in 4%, and fundoplication was undertaken in 30%. Complications were infrequent. Median length of stay was 1 day. After myotomy, the frequency and severity of symptoms of achalasia and reflux significantly decreased. Eighty-eight percent of patients felt their symptoms were greatly improved or resolved, and 90% felt their outcome was satisfying or better. Ninety-three percent felt they would undergo myotomy again, if necessary.


CONCLUSIONS
Laparoscopic Heller myotomy can safely and durably relieve symptoms of dysphagia while also reducing symptoms of reflux. Length of stay is short and patient satisfaction is very high with extended follow-up. Laparoscopic Heller myotomy is strongly encouraged for patients with symptomatic achalasia and is efficacious even after failures of dilation and/or Botox therapy.
Rosemurgy
Alexander
A
Department of Surgery, University of South Florida College of Medicine, Tampa, Florida 33601, USA. arosemur@hsc.usf.edu
Villadolid
Desiree
D
Thometz
Donald
D
Kalipersad
Candice
C
Rakita
Steven
S
Albrink
Michael
M
Johnson
Milton
M
Boyce
Worth
W
D000328:Adult; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002404:Catheterization; D016099:Endoscopy, Gastrointestinal / Q000009:adverse effects; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D017211:Treatment Failure
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A