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Updated: May 4, 2026
Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
Laparoscopic heller myotomy for achalasia cardia-initial experience in a teaching institute
Lileswar Kaman1, Javid Iqbal1, Rakesh Kochhar2
1Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Laparoscopic Heller-Dor surgery for esophageal achalasia is safe and effective. This procedure, utilizing hook electrocautery, demonstrates excellent clinical outcomes and is suitable for training surgical residents.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Minimally Invasive Surgery
Background:
- Esophageal achalasia necessitates surgical intervention, with laparoscopic Heller cardiomyotomy and Dor fundoplication being the preferred method.
- Advanced laparoscopic techniques are crucial for improving surgical outcomes and patient recovery.
Purpose of the Study:
- To evaluate the clinical outcomes and safety of the laparoscopic Heller-Dor procedure for achalasia.
- To assess the utility of this procedure as a training module for advanced laparoscopic surgery.
Main Methods:
- A single surgeon performed laparoscopic Heller myotomy with Dor fundoplication on 25 consecutive achalasia patients between 2005 and 2010.
- Preoperative diagnostics included upper GI series, esophagogastroscopy, and manometry to confirm diagnosis and rule out malignancy.
- Hook electrocautery was used for the myotomy in all laparoscopic procedures.
Main Results:
- The mean operative time was 93.3 minutes, with a mean blood loss of 90 ml.
- Median time to oral feeding was 2 days, and median hospital stay was 4 days.
- 96% of patients experienced excellent clinical response post-surgery, with 3 cases of intraoperative mucosal perforation successfully repaired laparoscopically.
Conclusions:
- Laparoscopic Heller-Dor operation using hook electrocautery is a safe, cost-effective, and highly effective treatment for esophageal achalasia.
- The procedure serves as a valuable teaching tool for advanced laparoscopic surgical training.
Abstract:
Laparoscopic Heller cardiomyotomy and Dor fundoplication is the surgical procedure of choice for esophageal achalasia. The aim of our study was to investigate the clinical outcome and safety of laparoscopic Heller-Dor procedure performed by using Hook electrocautery and as a teaching module for advanced laparoscopic surgery. Between January 2005 and December 2010, 25 consecutive patients with achalasia underwent laparoscopic Heller-Dor operation by a single surgeon. All the patients received upper gastrointestinal series (barium swallow), esophagogastroscopy, and esophageal manometry to exclude esophageal carcinoma and to confirm the diagnosis. All the patients were operated by laparoscopic modified Heller myotomy with Dor fundoplication by using hook electrocautery. Among 25 operated patients, 14 were male and 11 were female with a median age of 43 years (range 18-72 years). The mean operative time was 93.3 min (range 50-50 min), the mean operative blood loss was 90 ml (range 40-200 ml), the median time to oral feeding was 2 days (2-4 days), and the median hospital stay was 4 days (4-7 days). There was no conversion to open surgery. Intraoperative mucosal perforation was encountered in three patients and was repaired in all of them by laparoscopic suture. All the patients had an uneventful recovery without postoperative complication and had excellent clinical response (96 %) during follow-up. Laparoscopic Heller-Dor operation using hook electrocautery is safe, inexpensive, and effective treatment for achalasia which is useful for teaching and training surgical residents in advanced laparoscopic surgery.
