title: Long-term outcomes of laparoscopic heller cardiomyotomy without an anti-reflux procedure.
abstract: Certain technical features of laparoscopic Heller cardiomyotomy (LHM) remain controversial, including the extent of the myotomy and the indication for an antireflux procedure. We completed a retrospective chart review of all patients who underwent LHM for achalasia at 1 tertiary care institution to review our institutional experience with LHM without an antireflux procedure. Forty patients underwent a LHM performed by 2 surgeons, 65% of whom had previous medical management (Botox: 12 patients, LES dilatation: 14). The operating time was significantly increased in patients with Botox injections (98.3 vs. 71.1 minutes, P = 0.005). There were 3 intraoperative complications (mucosal injury in 3 patients, 2 had Botox injections). Postoperative evaluation demonstrated a mean dysphagia score of 0.2, a mean heartburn score of 3.2, and a mean LES pressure of 6.32 mm Hg. Thirty-two patients are maintained on acid-suppressing medications with good control of reflux symptoms. LHM without an antireflux procedure achieves excellent clinical outcomes in most patients with achalasia regardless of previous medical management. Previous medical management may present a greater technical challenge and may place patients at increased risk of mucosal injury.
authors.affiliation: Centre for Minimal Access Surgery, St. Joseph's Healthcare, McMaster University, Hamilton, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Gupta
authors.forename: C
authors.initials: C
authors.lastname: Sample
authors.forename: F
authors.initials: F
authors.lastname: Bamehriz
authors.forename: D
authors.initials: D
authors.lastname: Birch
authors.forename: M
authors.initials: M
authors.lastname: Anvari
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005764:Gastroesophageal Reflux / Q000517:prevention & control; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome