Heller Myotomy: To Wrap or Not to Wrap?

Area of Science:

• Gastroenterology
• Surgical Innovation
• Esophageal Disorders

Background:

• Achalasia is a primary esophageal motility disorder.
• Heller myotomy (HM) is a standard surgical treatment for achalasia.
• HM can be associated with postoperative gastroesophageal reflux disease (GERD).

Purpose of the Study:

• To evaluate the impact of antireflux procedures on postoperative dysphagia and reflux after laparoscopic Heller myotomy (LHM) for achalasia.
• To determine if antireflux procedures influence outcomes following LHM.
• To assess the independent effect of LHM on reflux symptoms.

Main Methods:

• A retrospective review of 63 patients undergoing laparoscopic Heller myotomy over five years.
• Patients received either myotomy alone, myotomy with reconstitution of the angle of His, or myotomy with partial fundoplication.
• Postoperative dysphagia and reflux symptoms were analyzed in relation to the surgical approach.

Main Results:

• Postoperative dysphagia occurred in 36.5% of patients; 56.5% of these had undergone an antireflux procedure.
• Gastroesophageal reflux was reported by 34.9% of patients postoperatively.
• Heller myotomy independently improved reflux status (P = 0.0014), irrespective of whether an antireflux procedure was performed.

Conclusions:

• Antireflux procedures did not significantly alter reflux status after Heller myotomy for achalasia.
• The addition of an antireflux procedure was not associated with increased postoperative dysphagia.
• Heller myotomy itself is independently associated with improved reflux symptoms in achalasia patients.