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 Oct-Dec;25(4):e2021.00054.
doi: 10.4293/JSLS.2021.00054.

To Wrap or Not to Wrap After Heller Myotomy

Muhammad B Darwish  1 , Shankar I Logarajah  1 , Kei Nagatomo  1 , Terence Jackson  1 , Annie Laurie Benzie  1 , Patrick James McLaren  1 , Edward Cho  1 , Houssam Osman  1 , D Rohan Jeyarajah  1
Affiliations

To Wrap or Not to Wrap After Heller Myotomy

Muhammad B Darwish et al. JSLS. 2021 Oct-Dec.

Abstract

Background and objectives: The primary aim of this study is to assess the necessity of fundoplication for reflux in patients undergoing Heller myotomy for achalasia. The secondary aim is to assess the safety of the robotic approach to Heller myotomy.

Methods: This is a single institution, retrospective analysis of 61 patients who underwent robotic Heller myotomy with or without fundoplication over a 4-year period (January 1, 2015 - December 31, 2019). Symptoms were evaluated using pre-operative and postoperative Eckardt scores at < 2 weeks (short-term) and 4 - 55 months (long-term) postoperatively. Incidence of gastroesophageal reflux and use of antacids postoperatively were assessed. Long-term patient satisfaction and quality of life (QOL) were assessed with a phone survey. Finally, the perioperative safety profile of robotic Heller myotomy was evaluated.

Results: The long-term average Eckardt score in patients undergoing Heller myotomy without fundoplication was notably lower than in patients with a fundoplication (0.72 vs 2.44). Gastroesophageal reflux rates were lower in patient without a fundoplication (16.0% vs 33.3%). Additionally, dysphagia rates were lower in patients without a fundoplication (32.0% vs 44.4%). Only 34.8% (8/25) of patients without fundoplication continued use of antacids in the long-term. There were no mortalities and a 4.2% complication rate with two delayed leaks.

Conclusion: Robotic Heller myotomy without fundoplication is safe and effective for achalasia. The rate of reflux symptoms and overall Eckardt scores were low postoperatively. Great patient satisfaction and QOL were observed in the long term. Our results suggest that fundoplication is unnecessary when performing Heller myotomy.

Keywords: Achalasia; Fundoplication; Heller myotomy; Myotomy; Robotic Heller myotomy.

PubMed Disclaimer

Conflict of interest statement

Conflict of interests: none.

Figures

Figure 1.
Figure 1.
Long-term Quality Of Life Phone Survey Questionnaire.
Figure 1.
Figure 1.
Long-term Quality Of Life Phone Survey Questionnaire.
Figure 2.
Figure 2.
Rates of symptoms pre-operatively, short-term postoperatively, and long-term postoperatively in patients who underwent a dor fundoplication compared to patients who did not receive a fundoplication.
Figure 3.
Figure 3.
Average Eckardt scores pre-operatively, short-term postoperatively, and long-term postoperatively.
See this image and copyright information in PMC

References

    1. Park W, Vaezi MF. Etiology and pathogenesis of achalasia: The current understanding. Am J Gastroenterol. 2005;100(6):1404–1414. - PubMed
    1. Wang P, Sharp K, Holzman M, Clements R. The outcome of laparoscopic Heller myotomy without antireflux procedure in patients with achalasia/Discussion. The American Surgeon. 1998;64(6):515. - PubMed
    1. Dempsey DT, Delano M, Bradley K, et al. . Laparoscopic esophagomyotomy for achalasia: does anterior hemifundoplication affect clinical outcome? Ann Surg. 2004;239(6):779-787. - PMC - PubMed
    1. Sharp KW, Khaitan L, Scholz S, Holzman MD, Richards WO. 100 consecutive minimally invasive heller myotomies: Lessons learned. Ann Surg. 2002;235(5):631–639. - PMC - PubMed
    1. Bloomston M, Rosemurgy A. Selective application of fundoplication during laparoscopic Heller myotomy ensures favorable outcomes. Surg Laparosc Endosc Percutan Tech. 2002;12(5):309-315. - PubMed

LinkOut - more resources