National outcomes of laparoscopic Heller myotomy: operative complications and risk factors for adverse events
Related Experiment Video
Updated: Apr 18, 2026
Author Spotlight: Cutting-Edge Robotic Heller Myotomy Protocol for Treatment of Achalasia
Published on: February 16, 2024
Samuel W Ross1, Bindhu Oommen1, Blair A Wormer1
1Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
Introduction:
Laparoscopic Heller myotomy (LHM) has supplanted an open approach due to decreased operative morbidity. Our goal was to quantify the incidence of peri-operative complications and identify risk factors for adverse outcomes in LHM.
Methods:
All LHM were queried from 2005 to 2011 from the National Surgical Quality Improvement Program database. Adverse outcomes were identified, and univariate and stepwise logistic regression (MVR) was then performed to quantify association.
Results:
There were 1,237 LHM in the study period. Patient averages were: age 51.9 ± 16.8 years, BMI 27.3 ± 6.6 kg/m(2), Charlson comorbidity index (CCI) 0.2 ± 0.6. 15.3 % had >10 % body mass loss in the preoperative 6 months. During surgery, 10.2 % underwent concomitant EGD, and mean operative time was 141.6 ± 63.4 min. There were 7(0.06 %) wound complications, 22(1.8 %) general complications, and 30(2.4 %) major complications. Average length of stay (LOS) was 2.8 ± 5.5 days. The rate of readmission and reoperation were 3.1 and 2.3 %, respectively, and there were 4(0.03 %) deaths. General and major complications were associated with alcohol use, pack-years of smoking, weight loss, history of stroke, radiation therapy, and longer operative times (p < 0.05); however, these factors did not remain significant on MVR (p > 0.05). Operative time was found to be significantly longer by 35.3 min for inpatients, 43.1 min in functionally dependent patients, 50.0 min in preoperative septic patients, and 17.2 min with concomitant EGD (p < 0.01 for all). LOS was found to be longer by 1.9 days for inpatients, 1.8 days in ASA category ≥3, and 1.2 days per one point increase in CCI (p < 0.001 for all).
Conclusion:
LHM is being performed nationally with a low incidence of operative complications and mortality. General and major complications following LHM are associated with patient alcohol use, pack-years of smoking, weight loss, history of stroke, radiation therapy, and longer operative times. Additionally, independent predictors of longer operative time and LOS were identified.
Insights
Laparoscopic Heller myotomy (LHM) is a safe procedure with low complication rates. Patient factors like alcohol use and smoking, along with longer operative times, are associated with increased risks, but independent predictors for operative time and length of stay were identified.
Area of Science:
- Minimally Invasive Surgery
- Gastrointestinal Surgery
- Surgical Outcomes Research
Background:
- Laparoscopic Heller myotomy (LHM) is preferred over open surgery due to reduced morbidity.
- Assessing peri-operative complications and risk factors in LHM is crucial for patient safety.
Purpose of the Study:
- To quantify the incidence of peri-operative complications following LHM.
- To identify patient-specific and procedure-related risk factors for adverse outcomes in LHM.
Main Methods:
- Analysis of 1,237 LHM procedures from the National Surgical Quality Improvement Program (NSQIP) database (2005-2011).
- Identification of adverse outcomes and application of univariate and multivariate logistic regression (MVR) to assess risk factors.
Main Results:
- Low rates of wound (0.06%), general (1.8%), and major (2.4%) complications were observed.
- Factors like alcohol use, smoking, weight loss, stroke history, radiation therapy, and longer operative times were associated with complications but not significant on MVR.
- Independent predictors for longer operative time included inpatient status, functional dependency, preoperative sepsis, and concomitant EGD. Longer length of stay (LOS) was associated with inpatient status, ASA class ≥3, and higher Charlson Comorbidity Index (CCI).
Conclusions:
- LHM demonstrates a low incidence of operative complications and mortality nationally.
- While several factors are associated with complications, independent predictors for operative time and LOS were identified, aiding in risk stratification and management.
- The study highlights the safety of LHM and identifies key factors influencing operative time and patient recovery.
