Chandler Wilfong, MD, Sharona B Ross, MD, FACS, Gilbert Immanuel, Nicholas Massanet, BS, Darrell J Downs, BS, Janelle Spence, BA, Iswanto Sucandy, MD, Alexander S Rosemurgy, MD, FACS. Florida Hospital Tampa
INTRODUCTION: This study was undertaken to analyze our decade long experience with LESS Heller myotomy. Achalasia is a rare esophageal motility disorder that affects 1 in 100,000 individuals. Currently, laparoscopic Heller myotomy with anterior fundoplication is the ‘gold standard’ therapy for achalasia, alleviating symptoms by de-functionalizing the lower esophageal sphincter mechanism. The advent of the Laparo-Endoscopic Single Site (LESS) technique provides a more minimally invasive approach to Heller myotomy.
METHODS AND PROCEDURES: With IRB approval, 179 patients who underwent LESS Heller myotomy with anterior fundoplication since 2007 have been prospectively followed. Patients self-assessed symptom frequency and severity preoperatively and postoperatively using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Patients scored their scar satisfaction (1 = revolting to 10 = beautiful). Data are presented as median (mean ± SD).
RESULTS: 51% of patients were men, of age 55 (53 ± 17) years, and BMI of 25 (25 ± 6.1) kg/m2. Patients had an operative time of 134 (135 ± 34.3) minutes with minimal blood loss. Intraoperative complications occurred in 5% of patients (e.g., esophagotomy) and postoperative complications occurred in 17% of patients (e.g., urinary retention, capnothorax). Length of stay was 1 (2 ± 2.1) day. Preoperatively, symptoms were frequent and severe (e.g., dysphagia=8/9); following myotomy, all symptoms queried were significantly less frequent and severe (e.g., dysphagia=1/0 p<0.001) with follow- up of 28 (34 ± 18.4) months (p<0.0001 for all, paired Student’s t-test). After myotomy, 88% of patients noted symptoms ‘less than once per month’. 87% of patients reported they were ‘Very Satisfied’ or ‘Satisfied’ with their experience and 95% of patients would undergo the operation again knowing what they know now. Patients scored their scar satisfaction as 10 (9 ± 1.6).
CONCLUSION: Heller myotomy with anterior fundoplication undertaken via the LESS approach provides efficacious, satisfactory, and durable amelioration of symptoms. Patients reported significant symptom resolution as well as satisfaction with their overall experience. Utilization of the LESS approach also provides superior cosmesis, as patients report tremendous satisfaction with their scar. Our decade of experience documenting the salutary benefits of LESS Heller myotomy should be more than enough to encourage surgeons to incorporate the approach into their armamentarium.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87407
Program Number: S097
Presentation Session: Foregut/Gastric Session
Presentation Type: Podium