Laparoscopic Heller myotomy relieves dysphagia in patients with achalasia and low LES pressure following pneumatic dilatation

Abstract

These results show that (a) a LES pressure of <10 mmHg after pneumatic dilatation does not guarantee relief of dysphagia, and (b) laparoscopic Heller myotomy relieves dysphagia in most patients with a postdilatation LES pressure <10 mmHg. Thus, a laparoscopic Heller myotomy is indicated if dilatation does not relieve dysphagia, even if LES pressure has been decreased to <10 mmHg. Esophagectomy should be reserved for the occasional failure of this simpler operation.

Preoperative lower esophageal sphincter pressure has little influence on the outcome of laparoscopic Heller myotomy for achalasia

“…In these cases, esophagectomy has been recommended as the only logical therapy, on the assumption that a Heller myotomy can do no more to relieve dysphagia [7,10]. However, when we tested this hypothesis and treated nine symptomatic patients with a hypotensive LES after pneumatic dilatation, dysphagia resolved in eight of them (89%) and the results were similar to those obtained in patients with a hypertensive LES [2]. These results suggest that a laparoscopic Heller myotomy is indicated if dilatation does not relieve dysphagia, even if the LES pressure has been decreased to less than 10 mmHg, and that esophagectomy should be reserved for the occasional failure of this simpler operation.…”

The laparoscopic reoperation of failed Heller myotomy

“…Esophagectomy carries a 3-5% mortality rate in the hands of even the most experienced surgeons, with substantial morbidity attributed to respiratory failure, anastomotic leak, and mediastinal bleeding [3]. Prolonged recovery times are noteworthy with a transabdominal or transthoracic approach, and the incidence of postoperative pulmonary and/or wound complications is increased.…”

Langzeitergebnisse nach Heller-Myotomie mit anteriorer Semifundoplikatio bei Achalasie

“…Somit sind auch bei Patienten mit stark dilatiertem Ösophagus oder hohen Ruhedrucken im unteren Ösophagussphinkter mit der Heller-Dor-Operation gute Langzeitergebnisse erreichbar, wie Diener et al bei Patienten mit niedrigem Ruhetonus eine symptomatische Besserung nachwiesen [5].…”