title: Revisional surgery after heller myotomy for treatment of achalasia: a comparative analysis focusing on operative approach.
abstract: Surgical myotomy is the gold standard in therapy for achalasia, but treatment failures occur and require revisional surgery. A MEDLINE search of peer-reviewed articles published in English from 1970 to December 2008 was performed using the following terms: esophageal achalasia, Heller myotomy, and revisional surgery. Thirty-three articles satisfied our inclusion criteria. A total of 12,727 patients, with mean age of 43.3 years (males 46% and females 50%), underwent Heller myotomy (open 94.8% and laparoscopic 5.2%). Revisional surgery was performed in 6.19%. Procedures performed included revision of the original myotomy or creation of a new myotomy with or without an antireflux procedure or esophagectomy. Reasons for reoperation were incomplete myotomy (51.8%), onset of reflux (34%), megaesophagus (16.2%), and esophageal carcinoma (3.04%). Systematic review of the literature for revisional surgery following Heller myotomy revealed a 6.19% rate of reoperation with a low mortality rate.
authors.affiliation: Department of General Surgery, P.D.Hinduja National Hospital and Medical Research Center, Veer Savarkar Marg, Mahim Mumbai, 400016 India.
authors.forename: Biswanath P
authors.initials: BP
authors.lastname: Gouda
authors.forename: Thomas
authors.initials: T
authors.lastname: Nelson
authors.forename: Sunil
authors.initials: S
authors.lastname: Bhoyrul
keywords: Achalasia; Heller myotomy; Revisional surgery
references.citation: Surg Today. 1996;26(7):541-5
references.pmid: 8840439
references.citation: Ann Chir. 2002 Dec;127(10):771-5
references.pmid: 12538098
references.citation: Br J Surg. 1976 Dec;63(12):949-53
references.pmid: 1009344
references.citation: Surg Endosc. 2003 Jul;17(7):1046-9
references.pmid: 12730729
references.citation: Ann Thorac Surg. 1996 Apr;61(4):1106-10; discussion 1110-1
references.pmid: 8607665
references.citation: Ann Thorac Surg. 2001 Dec;72(6):1909-12; discussion 1912-3
references.pmid: 11789770
references.citation: Surg Endosc. 2003 Jan;17(1):153-6
references.pmid: 12399873
references.citation: Dis Esophagus. 2003;16(4):284-90
references.pmid: 14641290
references.citation: Eur J Cardiothorac Surg. 1992;6(2):86-9; discussion 90
references.pmid: 1581086
references.citation: Br J Surg. 1971 Jun;58(6):466-8
references.pmid: 5089626
references.citation: Int Surg. 1982 Apr-Jun;67(2):103-10
references.pmid: 7118464
references.citation: J R Coll Surg Edinb. 1991 Jun;36(3):152-4
references.pmid: 1833541
references.citation: Surg Endosc. 2003 Jun;17(6):864-7
references.pmid: 12632134
references.citation: World J Gastroenterol. 2003 May;9(5):1129-31
references.pmid: 12717873
references.citation: J Gastrointest Surg. 2000 May-Jun;4(3):282-9
references.pmid: 10769091
references.citation: Surg Gynecol Obstet. 1983 Nov;157(5):450-4
references.pmid: 6635917
references.citation: J Thorac Cardiovasc Surg. 1984 Sep;88(3):344-51
references.pmid: 6471885
references.citation: JAMA. 1998 Aug 19;280(7):638-42
references.pmid: 9718057
references.citation: Hepatogastroenterology. 1991 Dec;38(6):488-92
references.pmid: 1778575
references.citation: Int Surg. 1988 Apr-Jun;73(2):69-77
references.pmid: 3397260
references.citation: Am J Surg. 1975 Apr;129(4):407-12
references.pmid: 1092194
references.citation: Ann Thorac Surg. 1984 Sep;38(3):201-6
references.pmid: 6476942
references.citation: World J Gastroenterol. 2004 Jan 15;10(2):287-91
references.pmid: 14716841
references.citation: Can J Surg. 1986 May;29(3):177-80
references.pmid: 3708456
references.citation: Mayo Clin Proc. 1969 Jul;44(7):478-83
references.pmid: 5788257
references.citation: Ann Thorac Surg. 1979 Aug;28(2):119-25
references.pmid: 89837
references.citation: Surg Endosc. 2002 May;16(5):772-6
references.pmid: 11997819
references.citation: Arch Surg. 1979 Aug;114(8):935-6
references.pmid: 464808
references.citation: Arch Surg. 1971 Aug;103(2):122-8
references.pmid: 5562798
references.citation: Ann Thorac Surg. 1994 Nov;58(5):1343-6; discussion 1346-7
references.pmid: 7979656
references.citation: J Thorac Cardiovasc Surg. 1986 Nov;92(5):859-65
references.pmid: 3773541
references.citation: Ann Surg. 2005 Apr;241(4):614-21
references.pmid: 15798463
references.citation: Ann Surg. 1923 May;77(5):615-7
references.pmid: 17864830
references.citation: Dis Esophagus. 1999;12(1):30-6
references.pmid: 10941858
references.citation: Br J Surg. 1987 Sep;74(9):765-9
references.pmid: 3311282
references.citation: Chest Surg Clin N Am. 1997 Aug;7(3):477-87; discussion 488
references.pmid: 9246398
references.citation: Gut. 1992 Aug;33(8):1011-5
references.pmid: 1398223
references.citation: Eur J Cardiothorac Surg. 2003 Oct;24(4):620-4
references.pmid: 14500084
references.citation: Br J Surg. 1993 Jul;80(7):882-5
references.pmid: 8369925