Operative interventions for failed heller myotomy: a single institution experience.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Foregut Surgery

Background:

• Achalasia treatment failures, including recurrent dysphagia and gastroesophageal reflux (GER), after Heller myotomy necessitate further surgical intervention.
• A single center's experience with surgical management of these post-myotomy complications is detailed.

Purpose of the Study:

• To evaluate the efficacy of different surgical approaches for patients experiencing treatment failure after Heller myotomy for achalasia.
• To stratify management based on preoperative symptoms and diagnostic findings.

Main Methods:

• Retrospective analysis of a prospectively collected database of 16 patients undergoing operative interventions between December 2003 and June 2009.
• Patients were categorized into three groups based on primary symptoms (dysphagia, GER, end-stage achalasia) and managed accordingly.
• Follow-up utilized a structured foregut questionnaire via telephone.

Main Results:

• Transabdominal redo Heller myotomy with partial fundoplication for recurrent dysphagia yielded good to excellent symptom relief in 7 of 8 patients.
• Redo partial fundoplication for uncontrolled GER showed poor outcomes, whereas short limb Roux-en-Y gastric bypass (SLRNYGB) provided excellent relief in 3 patients.
• Esophageal resection with reconstruction for end-stage achalasia resulted in excellent symptom relief for all 4 patients.

Conclusions:

• Transabdominal redo Heller myotomy is an effective surgical option for persistent dysphagia post-myotomy.
• Redo fundoplication for GER after prior myotomy has suboptimal results; SLRNYGB is a more effective alternative.
• Esophageal resection, despite its morbidity, remains a viable option for end-stage achalasia unresponsive to other treatments.