Redo laparoscopic Heller myotomy and Dor fundoplication versus rescue peroral endoscopic myotomy for esophageal achalasia after failed Heller myotomy: a single-institution experience.

Abstract

PURPOSE:

To compare the surgical outcomes of redo laparoscopic Heller-Dor procedure and rescue peroral endoscopic myotomy for patients with failed Heller myotomy.

METHODS:

We identified patients who had undergone redo laparoscopic Heller-Dor procedure or rescue peroral endoscopic myotomy from August 1996 to September 2019 and assessed the patients' characteristics, timed barium swallow results, symptom scores before/after surgery, surgical outcomes, and postoperative outcomes.

RESULTS:

Eleven patients underwent redo laparoscopic Heller-Dor procedure, and 14 underwent rescue peroral endoscopic myotomy. Blood loss (p = 0.001) and intraoperative complications rate (p = 0.003) were lower and the operative time (p > 0.001) and observation period (p = 0.009) shorter in patients who underwent rescue peroral endoscopic myotomy than in patients who underwent redo laparoscopic Heller-Dor procedure. Patients who underwent rescue peroral endoscopic myotomy had a higher rate of postoperative reflux esophagitis (p = 0.033) than those who underwent redo laparoscopic Heller-Dor procedure. After the interventions, the dysphagia symptoms were improved for both groups. Furthermore, both groups expressed satisfaction with their respective procedures.

CONCLUSIONS:

Rescue peroral endoscopic myotomy was associated with better surgical outcomes than redo laparoscopic Heller-Dor for patients with failed Heller myotomy. However, rescue peroral endoscopic myotomy had higher rates of postoperative reflux esophagitis.

• Authors: Shunsuke Akimoto, Fumiaki Yano, Nobuo Omura, Kazuto Tsuboi, Masato Hoshino, Se-Ryung Yamamoto, Takahiro Masuda, Yuki Sakashita, Naoko Fukushima, Hideyuki Kashiwagi, Toru Ikegami
• Journal: Surgery today (Surg Today) Vol. 52 Issue 3 Pg. 401-407 (Mar 2022) ISSN: 1436-2813 [Electronic] Japan
• PMID: 34535816 (Publication Type: Journal Article)
• Copyright: © 2021. Springer Nature Singapore Pte Ltd.

Topics

• Esophageal Achalasia (surgery)
• Fundoplication (methods)
• Gastroesophageal Reflux (surgery)
• Heller Myotomy (methods)
• Humans
• Laparoscopy (methods)
• Treatment Outcome