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Updated: Jun 26, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Laparoscopic Heller myotomy for achalasia: changing trend toward "true" day-case procedure
1Department of General and Upper GI Surgery, Birmingham Heartlands Hospital, Birmingham, United Kingdom. sanju_agrawal@hotmail.com
Insights
Laparoscopic Heller myotomy for achalasia can be a safe day-case procedure. This study shows good outcomes with short hospital stays, demonstrating feasibility for true day-case surgery.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Laparoscopic Heller myotomy is the standard treatment for achalasia.
- Previous studies report hospital stays exceeding one day.
- True day-case laparoscopic Heller myotomy has not been previously documented.
Purpose of the Study:
- To evaluate the feasibility and outcomes of laparoscopic Heller myotomy as a day-case procedure.
- To assess the length of hospital stay following laparoscopic Heller myotomy for achalasia.
Main Methods:
- A retrospective review of 24 consecutive patients undergoing laparoscopic Heller myotomy by a single surgeon.
- Procedure involved a 6 cm distal esophageal myotomy with anterior fundoplication.
- Patients were followed clinically at 6 weeks post-surgery.
Main Results:
- Average length of stay was 1.9 days (range 0-4 days).
- The last two patients were discharged same-day; five others within 23 hours.
- No adverse events, readmissions, or conversions to open surgery were reported.
- Good to excellent symptom relief was achieved in all patients, with 12% requiring later dilatation for recurrent dysphagia.
Conclusions:
- Laparoscopic Heller myotomy with anterior partial fundoplication is a safe and effective treatment for achalasia.
- The procedure is well-tolerated and can be successfully performed as a true day-case procedure.
- Early discharge following laparoscopic Heller myotomy is associated with good outcomes.
Background:
Laparoscopic Heller myotomy is the most effective therapy for achalasia. All case series have reported a minimum length of stay of more than 1 day. "True" day-case laparoscopic Heller myotomy has not been reported, so far. The aim of this study was to review our results with laparoscopic Heller myotomy with respect to the length of stay following the procedure.
Methods:
All patients undergoing laparoscopic Heller myotomy between August 2000 and July 2007 under the care of one surgeon were included in the study. This was performed by incising 6 cm of distal esophageal musculature, extending to 2 cm below the gastroesophageal junction. The myotomy was covered by an anterior fundoplication. All patients were reviewed in the clinic at a median of 6 weeks after surgery and, thereafter, if necessary.
Results:
Over the 7-year period, 24 consecutive patients with achalasia were treated in this manner. There were 13 women and 11 men, with an age range of 12-73 years. Intraoperative complications included mucosal perforation in 2 patients (sutured immediately) with no postoperative complications or conversion to open surgery. There were no deaths. The average length of stay was 1.9 days (range, 0-4). The last 2 patients were discharged on the same day, and the 5 previous to this were discharged within 23 hours of surgery. There were no adverse outcomes related to early discharge, and there were no readmissions. All patients reported good to excellent results with a relief of dysphagia on follow-up. Three patients (12%) developed recurrent dysphagia after an initial improvement, requiring dilatation only several months later.
Conclusions:
Based on our own experience, we believe that laparoscopic Heller myotomy with anterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia. It is well tolerated and can be considered a true day-case procedure.
