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

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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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All Science Journal Classification (ASJC) codes

  • Gastroenterology

Cite this

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