Doing more with less: our decade of experience with laparo-endoscopic single site Heller myotomy supports its applicatio
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and Other Interventional Techniques
Doing more with less: our decade of experience with laparo‑endoscopic single site Heller myotomy supports its application Chandler Wilfong1 · Sharona Ross1 · Michael Musumeci1 · Janelle Spence1 · Aviad Gravetz1 · Iswanto Sucandy1 · Alexander Rosemurgy1 Received: 21 May 2019 / Accepted: 28 October 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Achalasia is a rare esophageal motility disorder that affects 1 in 100,000 individuals. Currently, laparoscopic Heller myotomy with anterior fundoplication is the ‘gold standard’ therapy for achalasia, alleviating symptoms by de-functionalizing the lower esophageal sphincter mechanism. The advent of the Laparo-Endoscopic Single Site (LESS) technique provides a more minimally invasive approach to Heller myotomy. Methods With IRB approval, 179 patients who underwent LESS Heller myotomy with anterior fundoplication since 2007 have been prospectively followed. Patients self-assessed symptom frequency and severity preoperatively and postoperatively using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Patients scored their scar satisfaction (1 = revolting to 10 = beautiful). Data are presented as median (mean ± SD). Significance was accepted with 95% probability. Results Fifty-one percent of patients were men, of age 55 (53 ± 17) years and BMI of 25 (25 ± 6.1) kg/m2. Patients had an operative time of 134 (135 ± 34.3) minutes with an estimated blood loss (EBL) of 50 mL. Postoperative complications occurred in 18% of patients (e.g., urinary retention, capnothorax). Length of stay was 1 (2 ± 2.1) day. Preoperatively, symptoms (e.g., dysphagia, regurgitation) were frequent and severe; following myotomy, all symptoms queried were significantly less frequent and severe with follow-up of 28 (34 ± 18.4) months (p
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