Laparoscopic Heller myotomy for achalasia

BACKGROUND: Achalasia is an uncommon illness affecting 1 per 100,000 patients yearly. There is evidence to suggest viral, autoimmune, and hereditary etiologies. There are many treatment options available including medications, botulinum toxin injection, pneumatic dilation, and surgical myotomy. METHODS: We present a retrospective review of patients undergoing laparoscopic-modified Heller myotomy at a large referral and surgical training center. RESULTS: There were 36 patients identified. Thirty patients had undergone prior treatment with botulinum toxin injection, pneumatic dilation, previous Heller myotomy, or esophageal stenting. Immediate complications included mucosal perforation (2), spleen injury (1), and trocar-site infection (1). There were no postoperative esophageal leaks. Three patients suffered reflux requiring the daily use of a proton pump inhibitor 9 months after surgery. Three patients suffered recurrent dysphagia. CONCLUSIONS: Presently, there are little data to suggest an ideal management strategy in patients with achalasia. Our patient population consists predominantly of failures of other treatment methods submitted for laparoscopic myotomy. Our data suggest that laparoscopic Heller myotomy can be safely undertaken in this population, without a higher than expected rate of recurrent symptoms or reflux.