Long Term Outcomes of Surgical and Clinical Symptoms Following Minimally Invasive Heller Myotomy: A Retrospective Clinical Database Review
Digestive System Diseases | Gastroenterology | Medicine and Health Sciences | Surgery
Minimally invasive Heller myotomy rates have increased, but little evidence is available regarding long term clinical and surgical outcomes. Our aim was to evaluate long term symptom improvement and medication resolution for patients undergoing minimally invasive Heller myotomy.
A single-institution database was retrospectively reviewed for patients undergoing laparoscopic Heller myotomy (LHM) or robotic Heller myotomy (RHM) during 2007-2018. Patients with primary HM followed by a Dor fundoplication were included. Demographics and surgical data were analyzed. Esophageal symptoms, testing, and medication use were collected preoperatively (pre-op), at 6-month (6-mo), 12-month (12-mo), and long-term (LT; 12-mo+) follow-up. Analysis was performed using SPSS v.23.0, α=0.05.
Eighty eight patients (RHM:N=66; LHM:N=22) were included. The majority were male (62.5%) and Caucasian (89.8%), with a mean BMI of 27.3. Two patients had an intraoperative esophageal perforation, each repaired with a non-eventful postoperative course. Mean follow-up time was 71 months overall, 75 months [11-171 months] and 40 months [6-158 months] for LHM and RHM, respectively. All patients showed significant LT improvement of regurgitation, solid or liquid dysphagia, and Eckardt Score. Postoperative proton pump inhibitor (PPI) use was significantly lower at LT (LHM:31.3%, RHM:19.4%) compared to pre-op.
In this study, minimally invasive HM was a safe and effective treatment for achalasia symptom resolution in the long term. Therefore, in our experience, minimally invasive HM is a safe therapy that helps maintain symptom resolution.
Achalasia, Heller myotomy, robotic surgery
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Flores, L. E., Rodrigues Armijo, P., Pokala, B., Samreen, S., , Oleynikov, D. Long Term Outcomes of Surgical and Clinical Symptoms Following Minimally Invasive Heller Myotomy: A Retrospective Clinical Database Review. Graduate Medical Education Research Journal. 2019 Dec 13; 1(1).