Operative interventions for failed Heller myotomy

A single institution experience

Pradeep K. Pallati, Sumeet K. Mittal

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Recurrent dysphagia and/or gastroesophageal reflux (GER) are failures of treatment after Heller myotomy for achalasia. We present our single center experience with surgical interventions for these failures. We did a retrospective analysis of a prospectively collected database. Based on preoperative symptoms and endoscopy, esophagogram, and manometry results, patients were divided into three groups to guide management. Telephone follow-up was done using a structured foregut questionnaire. Between December 2003 and June 2009, 16 patients underwent operative interventions for disabling symptoms after previous Heller myotomy. Eight patients presented primarily with recurrent dysphagia and underwent transabdominal Heller myotomy with partial fundoplication. Seven patients reported good to excellent symptom relief at mean follow-up of 42 months. One patient reported no relief and eventually required esophageal bypass with retrosternal gastric pull-up. Four patients presented with uncontrolled GER. Two patients who underwent redo partial fundoplication reported poor symptomatic outcome and one patient has since undergone short limb Roux-en-y gastric bypass (SLRNYGB) with excellent symptom relief. The other two patients underwent SLRNYGB with excellent relief at 10 months. Four patients had end stage achalasia and underwent esophageal resection with reconstruction. All reported excellent symptom relief at mean follow-up of 36 months. Transabdominal redo Heller myotomy for dysphagia has good outcomes. Redo fundoplication for GER after previous myotomy has poor results and SLRNYGB is an effective option in these patients. Esophageal resection remains an effective, albeit morbid, option for end-stage achalasia.

Original languageEnglish
Pages (from-to)330-336
Number of pages7
JournalAmerican Surgeon
Volume77
Issue number3
StatePublished - Mar 2011

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Fundoplication
Esophageal Achalasia
Gastric Bypass
Deglutition Disorders
Gastroesophageal Reflux
Extremities
Manometry
Treatment Failure
Telephone
Endoscopy
Stomach
Databases

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Operative interventions for failed Heller myotomy : A single institution experience. / Pallati, Pradeep K.; Mittal, Sumeet K.

In: American Surgeon, Vol. 77, No. 3, 03.2011, p. 330-336.

Research output: Contribution to journalArticle

Pallati, Pradeep K. ; Mittal, Sumeet K. / Operative interventions for failed Heller myotomy : A single institution experience. In: American Surgeon. 2011 ; Vol. 77, No. 3. pp. 330-336.
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