Marc A Ward, MD, Christy M Dunst, MD, Ben Robinson, BS, Ezra N Teitelbaum, MD, Ahmed M Sharata, MD, Steven R DeMeester, MD, Kevin M Reavis, MD, Lee L Swanstrom, MD. The Oregon Clinic
Background: The laparoscopic Heller myotomy (LHM) was first adopted in the United States in 1993 and since has become the gold standard for the treatment of achalasia. We present our 20 year outcomes of our initial consecutive patient cohort.
Methods: Patients were identified in a prospectively maintained IRB-approved database (1993-1997). Post-operative Eckardt scores and a 5-point validated system questionnaires were obtained via the telephone. Success was defined by the lack of re-intervention as well as 20 year Eckardt scores < 3. All patients were invited to obtain an up-to-date esophagogastroduodenoscopy (EGD).
Results: Twenty-seven patients had a LHM (12 lost to follow-up, 4 deceased) during the specified time frame. Eleven patients were included in the study with a median follow-up of 20.2 years. Indications for LHM include achalasia (9) and diffuse esophageal spasm (2), with fundoplications being present in 9 patients. The rate of reintervention on either the stomach or the esophagus was 9.1%, with one patient requiring reoperation for a failed myotomy. The mean Eckardt score was 1, with all eleven patients reporting 20 year Eckardt scores < 3. One-hundred percent of patients were satisfied with the results of their surgery and reported a significant improvement in their quality of life. Classic gastroesophageal reflux symptoms (heartburn and regurgitation) were only present in 2 patients. Proton-pump inhibitors were being used by 44% of patients with excellent symptom control. Six patients accepted our invitation for a repeat EGD (median follow up time 18.3yrs) with 4 patients having normal anatomy and 2 having LA grade A esophagitis (1 patient on PPI). Barrett’s esophagus was not present in any of these patients.
Conclusion: Long-term results from our early experience with LHM are excellent and durable with only one patient requiring reintervention in 20 years. All patients in this study are satisfied with their operation and confirm it has led to a significant improvement in their quality of life.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79814
Program Number: P364
Presentation Session: Poster (Non CME)
Presentation Type: Poster
