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Laparoscopic re-operation for failed Heller myotomy.
1Department of Surgery, Creighton University, Omaha, Nebraska 68131, USA.
Summary
Laparoscopic re-operation for failed Heller myotomy in achalasia patients offers encouraging results, with significant symptom improvement and a feasible approach for managing persistent symptoms after initial surgery.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Esophageal Motility Disorders
Background:
- Laparoscopic Heller myotomy (LHM) for achalasia has a notable failure rate (10-20%), often necessitating re-operation.
- Persistent or recurrent symptoms post-LHM significantly impact patient quality of life.
Purpose of the Study:
- To evaluate the feasibility and outcomes of laparoscopic re-operation for patients with failed primary Heller myotomy.
- To identify common mechanisms of failure in primary LHM and assess the efficacy of revisional surgery.
Main Methods:
- Retrospective analysis of 15 patients undergoing laparoscopic re-operation for failed LHM between 1993 and 2004.
- Follow-up assessment via telephone questionnaire at a mean of 30 months post-re-operation.
- Analysis of primary surgery failure rates (5.6% in 106 patients) and mechanisms.
Main Results:
- Significant symptom improvement observed: 71% for dysphagia, 89% for regurgitation, 58% for heartburn, and 40% for chest pain.
- 50% reported excellent outcomes, and 79% would recommend the procedure.
- Re-operation failure occurred in 20% of patients, with 13% requiring conversion to open surgery.
Conclusions:
- Laparoscopic re-operation for failed Heller myotomy is a feasible and effective treatment option for achalasia.
- Encouraging symptom resolution rates suggest re-operation can successfully manage persistent symptoms after primary LHM.