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Updated: Jul 1, 2026
Robotic Heller Myotomy for Advancements in Surgical Management of Achalasia
Published on: February 16, 2024
Comparative long-term outcomes of Heller myotomy and peroral endoscopic myotomy
Samar Semaan1, Cynthia Kassab1, Warren C Naselsky1
1Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Suite 1661, Houston, TX, 77030, USA.
Background:
Achalasia is a rare esophageal motility disorder with two effective surgical interventions: Heller myotomy with fundoplication (Heller) and peroral endoscopic myotomy (POEM). Although both procedures alleviate dysphagia in the short term, there are limited data on long-term outcomes.
Methods:
We sent Eckardt, Dakkak Dysphagia, and GERD-HRQL questionnaires during four time periods between 2020 and 2025 to patients who had Heller or POEM between 2013 and 2016. We compared the final responses to the two interventions. Next, we analyzed electronic medical records to determine long-term PPI use and identify patients who underwent any additional subsequent interventions (dilation, Heller myotomy, POEM, or esophagectomy). We performed Kaplan-Meier analysis to determine the intervention-free survival.
Results:
A total of 172 patients underwent achalasia surgical intervention, with 81 and 91 patients in the Heller and POEM groups, respectively. There were no relevant significant differences in demographics and comorbidities, except for a higher rate of previous surgery at the gastroesophageal junction (18.7 vs. 4.9%, p < 0.01) in the POEM group. The survey was completed by 42% of patients (n = 72). There was no difference in the median Eckardt score (2 vs 3, p = 0.23), Dakkak dysphagia score (2 vs 3.5, p = 0.56), GERD-HRQL score (7 vs 7, p = 0.79) between patients who underwent Heller myotomy and POEM. However, significantly more patients in the POEM group (67.8%) were on PPI than those in the Heller group (41.8%, p < 0.01). Finally, there was a higher rate of any intervention in the POEM group (26.4%, n = 24) than in the Heller group (7.4%, n = 6), with a significant difference in intervention-free survival (p = 0.002, Fig. 1).
Conclusion:
Heller myotomy with fundoplication and POEM provide durable long-term symptom control in patients with achalasia. However, patients in the POEM group required more interventions and PPI to achieve similar results. Heller myotomy with fundoplication may be an ideal operation for treatment of achalasia.
