Top

Journal of Gastrointestinal Surgery

Published in:

01-12-2014 | How I do it

Laparoscopic Heller Myotomy as the Gold Standard for Treatment of Achalasia

Authors: Peter Nau, David Rattner

Published in: Journal of Gastrointestinal Surgery | Issue 12/2014

Abstract

Introduction

The recent introductions of novel methods for the treatment of achalasia as well as ongoing controversies about the merits of surgical and endoscopic treatment options have created controversy in identifying the optimal treatment for this condition. This lack of clarity prompted this review of 206 consecutive patients treated with a laparoscopic Heller (LH) myotomy over a 16-year period.

Methods

A retrospective review of a prospectively collected database was performed of 206 consecutive LH performed by a single surgeon.

Results

In this cohort, 58 % of patients had undergone a prior therapeutic intervention. Over 90 % of patients had relief of dysphagia post-operatively. There was one intraoperative esophageal perforation. There were no mortalities. Only 4/206 patients sustained complications that required either post-op therapeutic intervention or delayed hospital discharge.

Conclusion

This paper outlines an operative technique that has yielded outstanding results and may be used as a benchmark against which other therapies can be judged.

Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb. 1991; 36(3): 152–4.PubMed

Tatum RP, Pellegrini CA. How I do it: laparoscopic Heller myotomy with Toupet fundoplication for achalasia. J Gastrointest Surg. 2009; 13(6): 1120–4.PubMedCrossRef

Hunter JG, Trus TL, Branum GD, Waring JP. Laparoscopic Heller myotomy and fundoplication for achalasia. Ann Surg. 1997; 225(6): 655–64; discussion 664–5.PubMedCentralPubMedCrossRef

Lynch KL, Pandolfino JE, Howden CW, Kahrilas PJ. Major complications of pneumatic dilation and Heller myotomy for achalasia: single-center experience and systematic review of the literature. Am J Gastroenterol. 2012; 107(12): 1817–25.PubMedCrossRef

Iqbal A, Haider M, Desai K, Garg N, Kavan J, Mittal S, Filipi CJ. Technique and follow-up of minimally invasive Heller myotomy for achalasia. Surg Endosc. 2006; 20(3): 394–401.PubMedCrossRef

Beckingham IJ, Callanan M, Louw JA, Bornman PC. Laparoscopic cardiomyotomy for achalasia after failed balloon dilatation. Surg Endosc. 1999; 13(5): 493–6.PubMedCrossRef

Morino M, Rebecchi F, Festa V, Garrone C. Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy. Surg Endosc. 1997; 11(4): 359–61.PubMedCrossRef

Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia: a prospective randomized double-blind clinical trial. Ann Surg. 2004; 240(3): 405–12; discussion 412–5.PubMedCentralPubMedCrossRef

Malthaner RA, Tood TR, Miller L, Pearson FG. Long-term results in surgically managed esophageal achalasia. Ann Thorac Surg. 1994; 58(5): 1343–6; discussion 1346–7.PubMedCrossRef

10.

Wright AS, Williams CW, Pellegrini CA, Oelschlager BK. Long-term outcomes confirm the superior efficacy of extended Heller myotomy with Toupet fundoplication for achalasia. Surg Endosc. 2007; 21(5): 713–8.PubMedCrossRef

11.

Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg. 2003; 138(5): 490–5; discussion 495–7.PubMedCrossRef

12.

Tatum RP, Pellegrini CA. How I do it: laparoscopic Heller myotomy with Toupet fundoplication for achalasia. J Gastrointest Surg. 2009;13(6):1120–4.PubMedCrossRef

13.

Gutschow CA, Töx U, Leers J, Schäfer H, Prenzel KL, Hölscher AH. Botox, dilation, or myotomy? Clinical outcome of interventional and surgical therapies for achalasia. Langenbecks Arch Surg. 2010; 395(8): 1093–9.PubMedCrossRef

14.

Wang L, Li YM, Li L. Meta-analysis of randomized and controlled treatment trials for achalasia. Dig Dis Sci. 2009; 54(11): 2303–11.PubMedCrossRef

15.

Richter JE, Boeckxstaens GE. Management of achalasia: surgery or pneumatic dilation. Gut. 2011; 60(6): 869–76.PubMedCrossRef

16.

Vela MF, Richter JE, Khandwala F, Blackstone EH, Wachsberger D, Baker ME, Rice TW. The long-term efficacy of pneumatic dilatation and Heller myotomy for the treatment of achalasia. Clin Gastroenterol Hepatol. 2006; 4(5): 580–7.PubMedCrossRef

17.

Kostic S, Johnsson E, Kjellin A, Ruth M, Lönroth H, Andersson M, Lundell L. Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia: results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy. Surg Endosc. 2007; 21(7): 1184–9.PubMedCrossRef

18.

Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M, Satodate H, Odaka N, Itoh H, Kudo S. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010; 42(4): 265–71.PubMedCrossRef

19.

Campos GM, Vittinghoff E, Rabl C, Takata M, Gadenstätter M, Lin F, Ciovica R. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009; 249(1): 45–57.PubMedCrossRef

20.

Stavropoulos SN, Modayil RJ, Friedel D, Savides T. The international Per Oral Endoscopic Myotomy Survey (IPOEMS): a snapshot of the global POEM experience. Surg Endosc 2013; 327:3322–38CrossRef

21.

Pescarus R,Shlomovitz E, Swanstrom L L. Per-Oral Endoscopic Myotomy for Achalasia. Curr Gastroenterol Rep 2014;16:369–76PubMedCrossRef

Title: Laparoscopic Heller Myotomy as the Gold Standard for Treatment of Achalasia
Authors: Peter Nau
David Rattner
Publication date: 01-12-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 12/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-014-2655-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Laparoscopic Heller Myotomy as the Gold Standard for Treatment of Achalasia

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2014

Hospital Volume and Patient Outcomes in Hepato-Pancreatico-Biliary Surgery: Is Assessing Differences in Mortality Enough?

Quality of Life in Bile Duct Injury: 1-, 5-, and 10-year Outcomes After Surgical Repair

Re-examining the BMI Threshold for Bariatric Surgery in the USA

A Nomogram to Predict Disease-Free Survival After Surgical Resection of GIST

Obesity, Regardless of Comorbidity, Influences Outcomes After Colorectal Surgery—Time to Rethink the Pay-for-Performance Metrics?

Preoperative Bile Replacement Improves Immune Function for Jaundiced Patients Treated with External Biliary Drainage