Technique and follow-up of minimally invasive Heller myotomy for achalasia

• Published in: Surgical endoscopy Vol. 20; no. 3; pp. 394 - 401
• Main Authors: IQBAL, A, HAIDER, M, DESAI, K, GARG, N, KAVAN, J, MITTAL, S, FILIPI, C. J
• Format: Journal Article
• Language: English
• Published: New York, NY Springer 01.03.2006; Springer Nature B.V
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Barium; Biological and medical sciences; Child; Contrast Media; Diatrizoate Meglumine; Digestive System Surgical Procedures - adverse effects; Digestive System Surgical Procedures - methods; Digestive system. Abdomen; Dysphagia; Endoscopy; Esophageal Achalasia - pathology; Esophageal Achalasia - surgery; Esophageal Perforation - epidemiology; Esophagogastric Junction - pathology; Esophagus; Female; Follow-Up Studies; Gastroesophageal reflux; Humans; Intraoperative Complications - epidemiology; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Laparoscopy - adverse effects; Laparoscopy - methods; Male; Medical sciences; Middle Aged; Motility; Postoperative Complications - epidemiology; Questionnaires; Robotics; Thoracoscopy; Treatment Outcome; United States > US; da Vinci; Heller myotomy; Achalasia; Laparoscopy; Esophagogram; Endoscopy; Technique
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-005-0069-x

Laparoscopic Heller myotomy has been proven effective. Reliable predictive factors for outcome and the true benefit of the da Vinci robotic system, however, remain unknown. Seventy patients underwent laparoscopic Heller myotomy. The number of intraoperative perforations and the symptom-predictive value of postoperative esophagogram width measurement at the gastroesophageal junction were analyzed. The overall complication rate was 11%. Four patients experienced intraoperative perforation during the laparoscopic technique. No perforations were experienced with the da Vinci robotic system (n = 19). Of the total, 82% of patients had resolution of dysphagia, 91% of regurgitation, 91% of heartburn and 82% of chest pain. Immediate postoperative esophagogram gastroesophageal junction width demonstrated a positive predictive trend from 0 to 10 mm for dysphagia. Laparoscopic Heller myotomy is an effective treatment for achalasia. Immediate postoperative esophagogram gastroesophageal junction width measurement as a predictor for symptom resolution requires further study.