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Updated: May 7, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
[Laparoscopic myotomy in achalasia cardia treatment: experience after 36 operations]
Miloš Bjelović1, Bratislav Špica, Dragan Gunjić
1School of Medicine, University of Belgrade, Belgrade, Serbia; Center for Esophageal Surgery, First Surgical Clinic, Clinical Center of Serbia, Belgrade, Serbia. m.bjelovic@med.bg.ac.rs
Insights
The laparoscopic Heller-Dor operation is a safe and effective treatment for achalasia, with 94.4% of patients experiencing excellent or good outcomes. This minimally invasive surgery resolves symptoms and is the preferred treatment for achalasia.
Area of Science:
- Gastroenterology
- Minimally Invasive Surgery
- Surgical Outcomes
Background:
- Achalasia is a primary esophageal motility disorder.
- The laparoscopic Heller-Dor operation is a standard surgical approach for achalasia treatment.
- This study evaluates the initial experience with this procedure at a specialized center.
Purpose of the Study:
- To present the laparoscopic Heller-Dor operation technique.
- To report initial outcomes and patient experiences after 36 consecutive procedures.
- To assess the efficacy and safety of this surgical method for achalasia.
Main Methods:
- A partly retrospective, partly prospective study design.
- Standard anterior esophagocardimyotomy with partial fundoplication.
- Patient-reported symptom evaluation using questionnaires; diagnosis confirmed by radiology, endoscopy, and manometry.
Main Results:
- Dysphagia was the primary preoperative symptom in all patients.
- The average operative time was 127 minutes, with a mean hospital stay of 5.7 days.
- 94.4% of patients reported good or excellent treatment outcomes; 5.6% experienced manageable postoperative dysphagia.
Conclusions:
- Laparoscopic Heller-Dor operation is a highly effective and safe treatment for achalasia.
- The procedure demonstrates significant symptom resolution and patient satisfaction.
- It is considered the first-choice surgical method for managing achalasia.
Introduction:
Laparoscopic Heller-Dor operation, a standard method in the treatment of achalasia, has been performed at the Center for Esophageal Surgery of the First Surgical Clinic since April 2006.
Objective:
The aim of this study was to present this surgical procedure and initial experiences after 36 consecutive laparoscopic Heller-Dor operations.
Methods:
This partly retrospective, partly prospective study presented our results after laparoscopic Heller-Dor operation (presentation of the treatment method). We performed a standard anterior esophagocardioymiotomy, without releasing the posterior aspect of the cardia, and anterior partial fundoplication. The type and severity of symptoms and their duration were evaluated based on questionnaires fulfilled by patients. The diagnosis was made based on radiological, endoscopic and manometric findings. Laparoscopic surgery as the method of treatment was evaluated based on the duration of surgery, intra- and postoperative complications, time interval until the initiation of oral feeding, length of hospital stay, need for additional therapeutic measures after the operation and effect of surgery on the severity of symptoms.
Results:
Preopereratively, dysphagia was the predominant symptom in all patients, while regurgitation was much lower (44%). The average duration of operation was 127 minutes. Postoperative hospitalization lasted on the average 5.7 days. From 36 treated patients, 34 (94.4%) considered that the effect of treatment was good or excellent. Postoperative dysphagia was present in two patients (5.6%) and was successfully solved by balloon dilatation.
Conclusion:
Laparoscopic Heller-Dor operation is an effective and safe surgical procedure in resolving symptoms of achalasia and today presents the method of the first choice in the treatment of this disease.
