title: The feasibility, safety and outcomes of laparoscopic re-operation for achalasia.
abstract: BACKGROUND
  Heller myotomy for achalasia is associated with a recurrence rate of around 10%, thus reoperative surgery is often necessitated. This paper aims to review the available literature on laparoscopic reoperation for achalasia in order to assess its feasibility and effectiveness.
  
  
  METHODS
  A Medline, Embase, Ovid, Cochrane database and Google(TM) Scholar search was performed with the following Mesh terms: "laparoscopic", "redo", "reoperative", "Heller's", "esophagomyotomy" and "achalasia". Outcomes of interest included patient demographics and details of primary procedure, operative details, intra- and post operative complications and symptom scores.
  
  
  RESULTS
  Seven studies reported outcomes from 54 cases. Conversion occurred in 7% (4/54) of cases. Thirteen percent (7/54) of patients sustained intra-operative gastric or oesophageal perforation; however these were all noted and repaired intra-operatively leading to no subsequent morbidity. No deaths were reported. Pre- and post operative symptom scores were heterogeneous, however did appear to improve after the procedure.
  
  
  CONCLUSIONS
  This review demonstrates that laparoscopic reoperation for achalasia is feasible and safe with complication rates comparable to the primary laparoscopic operation. It is recommended that laparoscopic reoperative Heller's myotomy should only be performed by surgeons with special interest in oesophagogastric surgery and adequate experience in laparoscopic surgery for achalasia.
authors.affiliation: Department of Surgery and Cancer, St. Mary's Hospital, London, UK.
authors.forename: David R C
authors.initials: DR
authors.lastname: James
authors.forename: Sanjay
authors.initials: S
authors.lastname: Purkayastha
authors.forename: Omer
authors.initials: O
authors.lastname: Aziz
authors.forename: Iakovos
authors.initials: I
authors.lastname: Amygdalos
authors.forename: Ara W
authors.initials: AW
authors.lastname: Darzi
authors.forename: George B
authors.initials: GB
authors.lastname: Hanna
authors.forename: Emmanouil
authors.initials: E
authors.lastname: Zacharakis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004931:Esophageal Achalasia / Q000188:drug therapy / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult