title: Robotic-assisted Heller myotomy versus laparoscopic Heller myotomy for the treatment of esophageal achalasia: multicenter study.
abstract: Laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. The incidence of esophageal perforation reported is about 5%-10%. Robotically assisted Heller myotomy (RAHM) is emerging as a safe alternative to LHM. Data comparing the two approaches are scant. The aim of this study was to compare RAHM with LHM in terms of efficacy and safety for treatment of achalasia. A total of 121 patients underwent surgical treatment of achalasia at three institutions. A retrospective review of prospectively collected perioperative data was performed. Patients were divided into two groups: group A (RAHM), 59 patients, and group B (LHM), 62 patients. All the operations were completed using minimally invasive techniques. There were 63 women and 58 men, with a mean age of 45 +/- 19 years (14-82 years). Fifty-one percent of patients in group A and 95% of patients in group B reported weight loss. Duration of symptoms was equal for both groups. Dysphagia was the main complaint in both groups (P = NS). There was no difference in preoperative endoscopic treatment in both groups (44% versus 27%, P = NS). Operative time was significantly shorter for LHM in the first half of the experience (141 +/- 49 versus 122 +/- 44 minutes, P < .05). However, in the last 30 cases there was no difference in operative time between the groups (P = NS). Intraoperative complications (esophageal perforation) were more frequent in group B (16% versus 0%). The incidence of postoperative heartburn did not differ by group. There were no deaths. At 18 and 22 months, 92% and 90% of patients had relief of their dysphagia. This study suggests that RAHM is safer than LHM, because it decreases the incidence of esophageal perforation to 0%, even in patients who had previous treatment. At short-term follow-up, relief of dysphagia was equally achieved in both groups
authors.affiliation: Minimally Invasive Surgery, University of Illinois, Chicago, Illinois 60612, USA. shorgan@uic.edu
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
authors.forename: Carlos
authors.initials: C
authors.lastname: Galvani
authors.forename: Maria V
authors.initials: MV
authors.lastname: Gorodner
authors.forename: Pablo
authors.initials: P
authors.lastname: Omelanczuck
authors.forename: Fernando
authors.initials: F
authors.lastname: Elli
authors.forename: Federico
authors.initials: F
authors.lastname: Moser
authors.forename: Luis
authors.initials: L
authors.lastname: Durand
authors.forename: Miguel
authors.initials: M
authors.lastname: Caracoche
authors.forename: Jorge
authors.initials: J
authors.lastname: Nefa
authors.forename: Sergio
authors.initials: S
authors.lastname: Bustos
authors.forename: Phillip
authors.initials: P
authors.lastname: Donahue
authors.forename: Pedro
authors.initials: P
authors.lastname: Ferraina
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004931:Esophageal Achalasia / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome