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Updated: Jun 20, 2026
Robotic Heller Myotomy for Advancements in Surgical Management of Achalasia
Published on: February 16, 2024
Intraoperative upper GI endoscopy ensures an adequate laparoscopic Heller's myotomy
Boma T Adikibi1, Gordon A MacKinlay, Fraser D Munro
1Department of Pediatric Surgery, Royal Hospital for Sick Children, Edinburgh, Scotland, United Kingdom.
Introduction:
In this article, we present our case series of laparoscopic Heller's myotomies. These were all performed with the aid of intraoperative upper gastrointestinal (GI) endoscopy.
Materials And Methods:
During a 7-year period, 5 patients underwent a laparoscopic Heller's myotomy. There were 4 male patients and 1 female, with an average age of 12.1 years at operation (range, 9.3-14.9). One 14-year-old boy had had a laparoscopic Heller's procedure performed elsewhere and presented with severe dysphagia while undergoing orthopedic surgery in our hospital. His myotomy had been inadequate, and an intraoperative endoscopy had not been performed. All patients had preoperative upper GI contrast studies performed to confirm the diagnosis of achalasia. Two patients had manometry in addition to the contrast study. One patient had been treated with balloon dilatation preoperatively and another with botox injections. Endoscopy was performed pre- and postmyotomy to ensure adequacy.
Results:
There were no cases of intraoperative mucosal perforation or conversions to an open procedure. Sixty percent of patients required extension of the myotomy after intraoperative endoscopy. All patients had an uneventful, complication-free postoperative recovery.
Conclusion:
We feel that the addition of endoscopy during laparoscopic Heller's myotomy confers a significant advantage in ensuring that the myotomy is adequate. In our experience, the outcome has been excellent even after previous balloon dilatation or submucosal botox injections.
Insights
Intraoperative endoscopy during laparoscopic Heller myotomy ensures adequate treatment for achalasia, leading to excellent outcomes and complication-free recovery in this case series.
Area of Science:
- Minimally invasive surgery
- Gastrointestinal surgery
- Pediatric surgery
Background:
- Laparoscopic Heller myotomy is a surgical treatment for achalasia.
- Intraoperative upper gastrointestinal endoscopy can aid in assessing myotomy adequacy.
Purpose of the Study:
- To present a case series of laparoscopic Heller myotomies performed with intraoperative endoscopy.
- To evaluate the utility of intraoperative endoscopy in ensuring adequate myotomy and patient outcomes.
Main Methods:
- A 7-year case series of 5 patients (4 male, 1 female, average age 12.1 years) undergoing laparoscopic Heller myotomy.
- Preoperative diagnostics included upper GI contrast studies and, in some cases, manometry.
- Intraoperative endoscopy was used to assess and guide myotomy length, with pre- and postmyotomy endoscopy performed.
Main Results:
- No intraoperative mucosal perforations or conversions to open surgery occurred.
- Sixty percent of patients required myotomy extension based on intraoperative endoscopic findings.
- All patients experienced uneventful, complication-free postoperative recovery.
Conclusions:
- Intraoperative endoscopy significantly enhances the adequacy of laparoscopic Heller myotomy.
- Excellent outcomes were achieved, even in patients with prior treatments like balloon dilatation or botox injections.
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