Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Sep;35(9):4991-5000.
doi: 10.1007/s00464-020-07978-7. Epub 2020 Sep 23.

Does laparoscopic reoperation yield symptomatic improvements similar to those of primary laparoscopic Heller myotomy in achalasia patients?

Oscar Santes #  1 , Enrique Coss-Adame #  2 , Miguel A Valdovinos  2 , Janette Furuzawa-Carballeda  3 , Angélica Rodríguez-Garcés  4 , Jose Peralta-Figueroa  4 , Sofia Narvaez-Chavez  4 , Hector Olvera-Prado  4 , Uriel Clemente-Gutiérrez  1 , Gonzalo Torres-Villalobos  5   6
Affiliations

Does laparoscopic reoperation yield symptomatic improvements similar to those of primary laparoscopic Heller myotomy in achalasia patients?

Oscar Santes et al. Surg Endosc. 2021 Sep.

Abstract

Background: Laparoscopic Heller myotomy fails in approximately 3.5% to 15% of patients. Evidence of successful laparoscopic reoperation is limited to a few studies.

Methods: This case-control study was conducted in patients who underwent laparoscopic Heller myotomy reoperation (LHM-R) from 2008 to 2016. The operative outcomes, preoperative and last follow-up manometric parameters, and symptom questionnaire results, including the Eckardt, Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and eating assessment tool (EAT-10) scores, were obtained. The data were compared with those of patients who underwent primary laparoscopic Heller myotomy (LHM-1).

Results: Thirty-five patients who underwent LHM-R and 35 patients who underwent LHM-1 were included. The reasons for failure in the LHM-R patient group included incomplete myotomy (71.4%), myotomy fibrosis (25.7%) and structural alterations in fundoplication (2.9%). The follow-up duration was 34 months for the LHM-R group and 24 months for the LHM-1 group (p = 0.557). The procedure was performed by laparoscopy in 100% of the patients in the two groups. No differences were found regarding surgical morbidity (11.4% LHM-R vs. 2.9% LHM-1, p = 0.164). The symptomatic outcomes were equivalent between groups (Eckardt p = 0.063, EAT-10 p = 0.166, GERD-HRQL p = 0.075). An IRP < 15 mmHg was achieved in 100% of the LHM-R and LHM-1 patients. At the last follow-up, 82.1% of the LHM-R patients and 91.4% of the LHM-1 patients were in symptomatic remission (p = 0.271).

Conclusion: The results achieved with LHM-R are similar to those achieved with LHM-1. Laparoscopic reoperation should be considered an effective and safe treatment after a failed Heller myotomy.

Keywords: Achalasia; Heller myotomy; Laparoscopy; Reoperation.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

  • Robotic redo Heller myotomy: how I do it?
    Cubisino A, Schlottmann F, Dreifuss NH, Baz C, Mangano A, Masrur MA, Bianco FM, Giulianotti PC. Cubisino A, et al. Langenbecks Arch Surg. 2022 Jun;407(4):1721-1726. doi: 10.1007/s00423-022-02553-1. Epub 2022 May 18. Langenbecks Arch Surg. 2022. PMID: 35583834
  • Revisional Therapy for Recurrent Symptoms After Heller Myotomy for Achalasia.
    Milito P, Siboni S, Lovece A, Andreatta E, Asti E, Bonavina L. Milito P, et al. J Gastrointest Surg. 2022 Jan;26(1):64-69. doi: 10.1007/s11605-021-05098-8. Epub 2021 Aug 2. J Gastrointest Surg. 2022. PMID: 34341888 Free PMC article.

References

    1. Furuzawa-Carballeda J, Aguilar-León D, Gamboa-Domínguez A, Valdovinos MA, Nuñez-Álvarez C, Martín-del-Campo LA, Enríquez AB, Coss-Adame E, Svarch AE, Flores-Nájera A, Villa-Baños A, Ceballos JC, Torres-Villalobos G (2015) Achalasia—An autoimmune inflammatory disease: a cross-sectional study. J Immunol Res 2015:1–18. https://doi.org/10.1155/2015/729217 - DOI
    1. Furuzawa-Carballeda J, Torres-Landa S, Valdovinos MÁ, Coss-Adame E, Martín-del-Campo LA, Torres-Villalobos G (2016) New insights into the pathophysiology of achalasia and implications for future treatment. World J Gastroenterol 22:7892–7907. https://doi.org/10.3748/wjg.v22.i35.7892 - DOI - PubMed - PMC
    1. Furuzawa-Carballeda J, Zuñiga J, Hernández-Zaragoza DI, Barquera R, Marques-García E, Jiménez-Alvarez L, Cruz-Lagunas A, Ramírez G, Regino NE, Espinosa-Soto R, Yunis EJ, Romero-Hernández F, Azamar-Llamas D, Coss-Adame E, Valdovinos MA, Torres-Landa S, Palacios-Ramírez A, Breña B, Alejandro-Medrano E, Hernández-Ávila A, Granados J, Torres-Villalobos G (2018) An original Eurasian haplotype, HLA-DRB1*14:54-DQB1*05:03, influences the susceptibility to idiopathic achalasia. PLoS ONE 13:e0201676. https://doi.org/10.1371/journal.pone.0201676 - DOI - PubMed - PMC
    1. Verne GN, Hahn AB, Pineau BC, Hoffman BJ, Wojciechowski BW, Wu WC (1999) Association of HLA-DR and -DQ alleles with idiopathic achalasia. Gastroenterology 117:26–31 - DOI
    1. Williams VA, Peters JH (2009) Achalasia of the esophagus: a surgical disease. J Am Coll Surg 208:151–162. https://doi.org/10.1016/j.jamcollsurg.2008.08.027 - DOI - PubMed

LinkOut - more resources