Technique and follow-up of minimally invasive Heller myotomy for achalasia.
BACKGROUND
Laparoscopic Heller myotomy has been proven effective. Reliable predictive factors for outcome and the true benefit of the da Vinci robotic system, however, remain unknown.


METHODS
Seventy patients underwent laparoscopic Heller myotomy. The number of intraoperative perforations and the symptom-predictive value of postoperative esophagogram width measurement at the gastroesophageal junction were analyzed.


RESULTS
The overall complication rate was 11%. Four patients experienced intraoperative perforation during the laparoscopic technique. No perforations were experienced with the da Vinci robotic system (n = 19). Of the total, 82% of patients had resolution of dysphagia, 91% of regurgitation, 91% of heartburn and 82% of chest pain. Immediate postoperative esophagogram gastroesophageal junction width demonstrated a positive predictive trend from 0 to 10 mm for dysphagia.


CONCLUSIONS
Laparoscopic Heller myotomy is an effective treatment for achalasia. Immediate postoperative esophagogram gastroesophageal junction width measurement as a predictor for symptom resolution requires further study.
Iqbal
A
A
Department of Surgery, Creighton University School of Medicine, Omaha, NE 68131, USA.
Haider
M
M
Desai
K
K
Garg
N
N
Kavan
J
J
Mittal
S
S
Filipi
C J
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D003287:Contrast Media; D003974:Diatrizoate Meglumine; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004931:Esophageal Achalasia / Q000473:pathology / Q000601:surgery*; D004939:Esophageal Perforation / Q000453:epidemiology; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012371:Robotics; D013906:Thoracoscopy; D016896:Treatment Outcome
D003287:Contrast Media; D003974:Diatrizoate Meglumine