To Wrap or Not to Wrap After Heller Myotomy

Area of Science:

• Gastroenterology
• Minimally Invasive Surgery
• Surgical Oncology

Background:

• Achalasia is a rare esophageal motility disorder.
• Heller myotomy is a standard surgical treatment for achalasia.
• The role of fundoplication in conjunction with Heller myotomy for reflux remains debated.

Purpose of the Study:

• To evaluate the necessity of fundoplication during robotic Heller myotomy for achalasia.
• To assess the safety and efficacy of robotic Heller myotomy.
• To analyze long-term patient outcomes, including reflux, dysphagia, satisfaction, and quality of life.

Main Methods:

• Retrospective analysis of 61 patients undergoing robotic Heller myotomy with or without fundoplication.
• Symptom evaluation using Eckardt scores (pre- and post-operative).
• Assessment of gastroesophageal reflux, antacid use, patient satisfaction, and quality of life.

Main Results:

• Lower long-term Eckardt scores (0.72 vs 2.44) and reflux rates (16.0% vs 33.3%) in patients without fundoplication.
• Reduced dysphagia rates (32.0% vs 44.4%) and long-term antacid use (34.8%) in the no-fundoplication group.
• Robotic Heller myotomy demonstrated a 4.2% complication rate with no mortalities.

Conclusions:

• Robotic Heller myotomy without fundoplication is a safe and effective treatment for achalasia.
• The procedure results in low rates of reflux and dysphagia, with high long-term patient satisfaction.
• Fundoplication appears unnecessary when performing Heller myotomy for achalasia.