Concurrent surgical management of achalasia and obesity: a Metabolic and Bariatric Surgery Accreditation and Quality...

The safety of concurrent Heller myotomy (HM) and metabolic bariatric surgery (MBS) remains underexplored, with existing literature limited to case reports. This study aimed to evaluate the 30-day postoperative outcomes of concurrent HM-MBS vs MBS alone.

A retrospective analysis of the 2020-2023 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database was conducted. HM-MBS cases were identified. To minimize confounding, propensity score matching (1:3) was performed using 25 preoperative characteristics. The 30-day postoperative outcomes and complications, categorized using the Clavien-Dindo classification (CDC), were compared between the HM-MBS and MBS groups using independent samples t tests/rank-sum and chi-square tests/Fisher exact tests. Subgroup analyses were performed for the primary and conversion procedures.

After matching, 336 patients (HM-MBS: n = 84; MBS: n = 252; mean age: 52.3 ± 10.9 years; 85.4% female) were analyzed, including 236 primary and 100 conversion procedures. Compared with the MBS group, the HM-MBS group had significantly prolonged operative times (123.6 ± 59.8 vs 210.9 ± 72.3 minutes, respectively; P <.001) and hospital stays (1.56 ± 1.20 vs 3.60 ± 6.90 days, respectively; P =.007). Overall complications were higher in the HM-MBS group than in the MBS group (27.4% vs 10.7%, respectively; P <.001), including increased gastrointestinal bleeding (3.6% vs 0.0%, respectively; P =.015), surgical site infections (6.0% vs 1.2%, respectively; P =.026), ventilator support (3.6% vs 0.0%, respectively; P =.015), and sepsis (6.0% vs 0.4%, respectively; P =.004). The rates of severe complications (CDC grade ≥ IIIa) were higher in the HM-MBS group than in the MBS group (overall: 16.7% vs 2.8%, respectively; P <.001; reoperation: 8.3% vs 1.6%, respectively; P =.007; reintervention: 8.3% vs 1.2%, respectively; P =.003). Subgroup analyses revealed similar patterns across the primary and conversion procedures.

Concurrent HM-MBS is associated with significantly higher postoperative morbidity, suggesting the need for careful consideration of surgical timing in patients who require both procedures.