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Updated: Mar 14, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Evaluation of outcome after cardiomyotomy for achalasia using the Chicago classification
P W Hamer1,2, R H Holloway3,4, R Heddle5
1Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia.
Insights
Achalasia manometric subtypes predict treatment outcomes. Type III achalasia indicates a poorer prognosis following Heller
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Esophageal Motility Disorders
Background:
- Achalasia is classified into manometric subtypes using the Chicago classification.
- These subtypes are hypothesized to correlate with treatment success.
- Laparoscopic Heller's cardiomyotomy with anterior fundoplication is a common treatment for achalasia.
Purpose of the Study:
- To investigate whether achalasia subtypes predict outcomes after laparoscopic Heller's cardiomyotomy.
- To compare the success rates of cardiomyotomy across different achalasia subtypes.
Main Methods:
- Retrospective analysis of patients undergoing Heller's cardiomyotomy for achalasia (June 1993 - March 2015).
- Manometry tracings were re-reported according to the Chicago classification.
- Outcomes assessed via postal questionnaire using the modified Eckardt score; success defined as a score ≤3 and no further intervention.
Main Results:
- Type III achalasia patients were older (mean 63 years) compared to Type I/II (mean 49-50 years).
- Type III achalasia showed a significantly lower success rate (31%) post-cardiac myotomy compared to Type II (66%) and Type I (69%).
- No significant difference in outcomes was observed between Type I and Type II achalasia.
Conclusions:
- Achalasia Type III is a significant predictor of unfavorable outcomes after cardiomyotomy.
- Achalasia Types I and II demonstrate comparable outcomes following this surgical procedure.
Background:
Achalasia can be subdivided into manometric subtypes according to the Chicago classification. These subtypes are proposed to predict outcome after treatment. This hypothesis was tested using a database of patients who underwent laparoscopic Heller's cardiomyotomy with anterior fundoplication.
Methods:
All patients who underwent Heller's cardiomyotomy for achalasia between June 1993 and March 2015 were identified from an institutional database. Manometry tracings were retrieved and re-reported according the Chicago classification. Outcome was assessed by a postal questionnaire, and designated a success if the modified Eckardt score was 3 or less, and the patient had not undergone subsequent surgery or pneumatic dilatation. Difference in outcome after cardiomyotomy was analysed with a mixed-effects logistic regression model.
Results:
Sixty, 111 and 24 patients had type I, II and II achalasia respectively. Patients with type III achalasia were more likely to be older than those with type I or II (mean age 63 versus 50 and 49 years respectively; P = 0·001). Some 176 of 195 patients returned questionnaires after surgery. Type III achalasia was less likely to have a successful outcome than type II (odds ratio (OR) 0·38, 95 per cent c.i. 0·15 to 0·94; P = 0·035). There was no significant difference in outcome between types I and II achalasia (II versus I: OR 0·87, 0·47 to 1·60; P 0·663). The success rate at 3-year follow-up was 69 per cent (22 of 32) for type I, 66 per cent (33 of 50) for type II and 31 per cent (4 of 13) for type III.
Conclusion:
Type III achalasia is a predictor of poor outcome after cardiomyotomy. There was no difference in outcome between types I and II achalasia.
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