Does laparoscopic reoperation yield symptomatic improvements similar to those of primary laparoscopic Heller myotomy in
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and Other Interventional Techniques
Does laparoscopic reoperation yield symptomatic improvements similar to those of primary laparoscopic Heller myotomy in achalasia patients? Oscar Santes1 · Enrique Coss‑Adame2 · Miguel A. Valdovinos2 · Janette Furuzawa‑Carballeda3 · Angélica Rodríguez‑Garcés4 · Jose Peralta‑Figueroa4 · Sofia Narvaez‑Chavez4 · Hector Olvera‑Prado4 · Uriel Clemente‑Gutiérrez1 · Gonzalo Torres‑Villalobos1,4 Received: 8 July 2019 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Laparoscopic Heller myotomy fails in approximately 3.5% to 15% of patients. Evidence of successful laparoscopic reoperation is limited to a few studies. Methods This case–control study was conducted in patients who underwent laparoscopic Heller myotomy reoperation (LHM-R) from 2008 to 2016. The operative outcomes, preoperative and last follow-up manometric parameters, and symptom questionnaire results, including the Eckardt, Gastroesophageal Reflux Disease-Health Related Quality of Life (GERD-HRQL) and eating assessment tool (EAT-10) scores, were obtained. The data were compared with those of patients who underwent primary laparoscopic Heller myotomy (LHM-1). Results Thirty-five patients who underwent LHM-R and 35 patients who underwent LHM-1 were included. The reasons for failure in the LHM-R patient group included incomplete myotomy (71.4%), myotomy fibrosis (25.7%) and structural alterations in fundoplication (2.9%). The follow-up duration was 34 months for the LHM-R group and 24 months for the LHM-1 group (p = 0.557). The procedure was performed by laparoscopy in 100% of the patients in the two groups. No differences were found regarding surgical morbidity (11.4% LHM-R vs. 2.9% LHM-1, p = 0.164). The symptomatic outcomes were equivalent between groups (Eckardt p = 0.063, EAT–10 p = 0.166, GERD–HRQL p = 0.075). An IRP 89% of patients in the long-term [7–11]. Nevertheless, 3.5% to 15% of patients experience treatment failure, which is defined as persistent or recurrent dysphagia after Heller myotomy (HM) [12]. There is currently no consensus regarding the optimal management approach for this group of patients. Most patients are treated according to the preferences and experience of the treating medical group. The therapeutic options for LHM failure include endoscopic pneumatic dilation (PD), POEM, esophagectomy, and LHM-R. PD for the treatment of LHM failure has a variable success rate, ranging from 50 to 89.5% [11, 13–20]. It should be mentioned that in most patients, multiple dilatations are required. POEM after failed surgical myotomy has been shown to be successful in 81% to 100% of cases; however, these studies included a small number of cases and a followup period of less than one year [21–23]. Esophageal resection effectively restores the ability to swallow and improves patient quality of life, albeit with significantly high morbidity and mortality (up to 50% and 10%, respectively), which is not acceptable, considering that achalasia is a ben
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