Laparoscopic re-operation for failed Heller myotomy

A. Iqbal, B. Tierney, M. Haider, V. K. Salinas, A. Karu, K. K. Turaga, S. K. Mittal, Charles Filipi

Research output: Contribution to journalArticle

47 Citations (Scopus)

Abstract

Laparoscopic Heller myotomy for achalasia has a 10-20% failure rate and may require re-operation to control persistent or recurrent symptoms. We report follow-up of 15 patients who underwent laparoscopic re-operation for failed Heller myotomy. Between 1993 and 2004, 15 patients underwent laparoscopic re-operation for failed Heller myotomy at our center. The mean duration between procedures was 23 months. Follow-up was completed at a mean duration of 30 months in 14 patients (93%) via a telephone questionnaire. Our overall failure rate for primary surgery (n = 106) was 5.6%. The mechanisms of failure were incomplete myotomy (33%), myotomy fibrosis (27%), fundoplication disruption (13%), too tight fundoplication (7%) and a combination of myotomy fibrosis and incomplete myotomy (20%). Significant symptom improvement was observed with postoperative symptom resolution seen in 71% of patients with dysphagia, 89% for regurgitation, 58% for heartburn and 40% for chest pain. Fifty percent reported excellent results and 79% would recommend the procedure to a friend. Subsequent dilations were performed in four patients (29%). Two patients required conversion to open surgery (13%). Three patients (20%) failed the re-operation and required further revisional surgery. Complications included intraoperative perforation in three (none of which resulted in postoperative morbidity) and a pneumothorax in one patient. Prior endoscopic therapies (pneumatic dilation or Botulinum toxin) were not associated with poor results. Laparoscopic re-operation for failed Heller myotomy is feasible and results are encouraging.

Original languageEnglish
Pages (from-to)193-199
Number of pages7
JournalDiseases of the Esophagus
Volume19
Issue number3
DOIs
StatePublished - Jun 2006

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Fundoplication
Dilatation
Fibrosis
Conversion to Open Surgery
Heartburn
Esophageal Achalasia
Botulinum Toxins
Intraoperative Complications
Pneumothorax
Deglutition Disorders
Chest Pain
Telephone
Morbidity
Therapeutics
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

Iqbal, A., Tierney, B., Haider, M., Salinas, V. K., Karu, A., Turaga, K. K., ... Filipi, C. (2006). Laparoscopic re-operation for failed Heller myotomy. Diseases of the Esophagus, 19(3), 193-199. https://doi.org/10.1111/j.1442-2050.2006.00564.x

Laparoscopic re-operation for failed Heller myotomy. / Iqbal, A.; Tierney, B.; Haider, M.; Salinas, V. K.; Karu, A.; Turaga, K. K.; Mittal, S. K.; Filipi, Charles.

In: Diseases of the Esophagus, Vol. 19, No. 3, 06.2006, p. 193-199.

Research output: Contribution to journalArticle

Iqbal, A, Tierney, B, Haider, M, Salinas, VK, Karu, A, Turaga, KK, Mittal, SK & Filipi, C 2006, 'Laparoscopic re-operation for failed Heller myotomy', Diseases of the Esophagus, vol. 19, no. 3, pp. 193-199. https://doi.org/10.1111/j.1442-2050.2006.00564.x
Iqbal A, Tierney B, Haider M, Salinas VK, Karu A, Turaga KK et al. Laparoscopic re-operation for failed Heller myotomy. Diseases of the Esophagus. 2006 Jun;19(3):193-199. https://doi.org/10.1111/j.1442-2050.2006.00564.x
Iqbal, A. ; Tierney, B. ; Haider, M. ; Salinas, V. K. ; Karu, A. ; Turaga, K. K. ; Mittal, S. K. ; Filipi, Charles. / Laparoscopic re-operation for failed Heller myotomy. In: Diseases of the Esophagus. 2006 ; Vol. 19, No. 3. pp. 193-199.
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