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.