A Single Institution’s First 100 Patients Undergoing Laparoscopic Heller Myotomy: Do Long-Term Outcomes Justify Continued Application?

Alexander S Rosemurgy, MD, Janelle Spence, BS, Darrell J Downs, ATC, Mark Giorgi, Christian B Rodriguez, BS, Indraneil Mukherjee, MD, Sharona B Ross, MD. Florida Hospital Tampa

Introduction: This study was undertaken to report long-term outcomes after laparoscopic Heller myotomies performed more than 15 years ago to determine if outcomes are salutary and durable, and support continued application of laparoscopic Heller myotomy as first-line therapy for achalasia.

Methods: With IRB approval, patients have been prospectively followed after Heller myotomy. Patients scored the frequency and severity of symptoms using a Likert scale (0=never/not bothersome to 10=always/very bothersome). Pre- and post-operative outcomes with Heller myotomy are compared. Data are presented as median or median (mean ± SD), where appropriate.

Results: 100 patients (55% men, age 48 years, BMI 24 kg/m2) underwent laparoscopic Heller myotomy prior to 2000. For all patients, follow-up is 10 years (10 ± 5.3); with myotomy, dysphagia frequency fell from 10 (9 ± 2.1) to 4 (4 ± 2.8) and dysphagia severity fell from 10 (9 ± 2.4) to 2 (3 ± 2.9) (p<0.001 for each) without the development of reflux related symptoms (e.g., heartburn) (Table). 29 patients were followed to death 7 years (7 ± 4.4) after Heller myotomy undertaken at age 71 years (69 ± 12.7), 55 patients are currently “lost to follow-up” after follow-up of 9 years (8 ± 4.03), and 16 patients are “currently followed” at 17 years (17 ± 1.1). Duration of follow-up did not impact the frequency or severity of symptoms (Table). 83% of patients are satisfied or very satisfied and 89% would have the operation again, knowing what they now know.

Conclusions:  Long-term follow-up after laparoscopic Heller myotomy documents patient satisfaction and durable symptomatic relief without troublesome new symptoms. Durable salutary benefits after laparoscopic Heller myotomy justify its continued application as first-line therapy for achalasia.

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