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Updated: Aug 17, 2026
Robotic Heller Myotomy for Advancements in Surgical Management of Achalasia
Published on: February 16, 2024
Laparoscopic Heller myotomy for achalasia
Robert N Cacchione1, Dan N Tran, Diane H Rhoden
1Department of Surgery, University of Louisville School of Medicine, 2nd Floor ACB, Louisville, KY 40202, USA. Robert.cacchione@louisville.edu
Insights
Laparoscopic Heller myotomy is a safe option for achalasia patients who failed other treatments. This surgery showed acceptable rates of symptom recurrence and reflux in a recent study.
Area of Science:
- Gastroenterology
- Surgical Innovation
Background:
- Achalasia is a rare esophageal motility disorder affecting 1 in 100,000 individuals annually.
- Potential etiologies include viral, autoimmune, and hereditary factors.
- Established treatments include medications, botulinum toxin, pneumatic dilation, and surgical myotomy.
Purpose of the Study:
- To evaluate the safety and efficacy of laparoscopic-modified Heller myotomy in patients with achalasia.
- To assess outcomes in a patient population with a history of treatment failure.
Main Methods:
- Retrospective review of patients undergoing laparoscopic-modified Heller myotomy at a major surgical center.
- Analysis of patient data including prior treatments, immediate complications, and long-term outcomes.
Main Results:
- 36 patients were identified; 30 had prior treatments (botulinum toxin, dilation, prior myotomy, stenting).
- Immediate complications included mucosal perforation (2), spleen injury (1), and trocar-site infection (1). No postoperative leaks occurred.
- 9 months post-surgery, 3 patients experienced reflux requiring daily PPIs, and 3 had recurrent dysphagia.
Conclusions:
- Laparoscopic Heller myotomy appears to be a safe procedure for achalasia patients, even those with prior treatment failures.
- The rate of recurrent symptoms and reflux in this challenging patient group was not higher than expected.
- Further data are needed to establish an ideal management strategy 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.
