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Related Experiment Videos

Management of failed Heller's operations

J Kiss1, A Vörös, E Szirányi

  • 1Department of Surgery, Imre Haynal University of Health Sciences, Postgraduate Medical School, Budapest, Hungary.

Surgery Today
|January 1, 1996
PubMed
Summary

Reoperations for failed Heller myotomy often stem from incomplete myotomy or reflux. Addressing these issues with revised myotomy and antireflux repair yields good to excellent outcomes in most patients.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Esophageal Surgery

Background:

  • Heller's esophagocardiomyotomy is a surgical procedure for achalasia.
  • Failure of the initial procedure necessitates reoperation.
  • Common causes of failure include inadequate myotomy and iatrogenic gastroesophageal reflux.

Purpose of the Study:

  • To analyze reoperations for failed Heller's esophagocardiomyotomy.
  • To identify causes of failure and evaluate treatment outcomes.
  • To emphasize essential surgical considerations for successful reoperation.

Main Methods:

  • Retrospective analysis of 29 patients undergoing 33 reoperations for failed Heller's myotomy (1972-1992).
  • Review of patient symptoms and diagnostic findings to determine failure etiology.

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  • Surgical techniques included repeat myotomy with antireflux repair, esophagoplication, and esophagojejunogastric loop interposition.

    • Main Results:

    • Reoperations were primarily due to insufficient myotomy length/depth or reflux complications.
    • No deaths occurred post-reoperation.
    • Excellent or good results were achieved in 23 cases, with fair results in 3 cases.

    Conclusions:

    • Careful diagnosis is crucial for identifying the cause of Heller myotomy failure.
    • Revision of inadequate myotomy combined with effective antireflux repair is key.
    • Abolishing the "sigmoid sac" is vital for successful outcomes, even with adequate esophagogastric junction diameter.