Laparoscopic Redo Heller Myotomy for Persistent Achalasia

Dustin G Williams, MD, Jose C Hernandez, MD, Alyssa B Chapital, MD PhD, Kristi L Harold, MD. Mayo Clinic Arizona

Heller myotomy is the standard surgical procedure performed in patients with achalasia. However, after undergoing Heller myotomy some patients have persistent symptoms of their disease and undergo a redo procedure. This report presents retrospective data on laparoscopic redo Heller myotomy for persistent achalasia at Mayo Clinic in Arizona (MCA).

Patients who underwent laparoscopic redo Heller myotomy at MCA, between January 2003 and September 2010 were reviewed

15 patients (11 males, and 4 females) met study criteria and were reviewed. Median age was 52 years (26-79 years), and median BMI was 26 (15.1-43.9). The median time between procedures was 8 years (range 1 to 46 years), and 6 patients (40%) had a recurrence of symptoms within 6 months of their first myotomy (range immediately to 40 years). 7 patients had received Botulinim toxin injections, and 10 patients had received dilatations between their two myotomies. Pre-operativly 14 patients had undergone esophageal manometry and results were abnormal in all patients. Median operating time was 174 min (range 82-376min), median estimated blood loss was 50 ml (range 25-100 ml), and median hospital stay was 2 days (range 1-5 days). Myotomy was extended to a median length of 9.8 cm along the esophagus (6-10 cm), and 4 cm along the stomach (2-6 cm). Diverticulectomy was performed in one patient (7%), and 8 (53%) patients were given an anti-reflux procedure which consisted of one Dor fundoplication, and 7 Toupet fundoplications. Only 1 patient (7%) had a complicated post-op course involving a GI bleed and gastroparesis. After a median follow-up of 27 months (range 1-85 months) 4 patients (27%) experienced recurring symptoms post op. These included mild dysphagia (13%), heartburn (20%), chest pain (20%), and regurgitation (13%) which led one patient (7%) to pursue esophagectomy 16 months after redo myotomy. Neither Botulinum toxin nor dilation were associated with poor results.

Laparoscopic redo Heller myotomy is associated with encouraging results. Morbidity was low at 7% and surgery was associated with a 73% success rate.

Session: Poster
Program Number: P266
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