Introduction: Laparoscopic Heller myotomy is a first-line treatment for achalasia. To improve outcomes after myotomy and to determine if poor early results predict later outcomes, emergency department (ED) visits and rehospitalizations within 60 days following laparoscopic Heller myotomy were studied.
Methods: Since 1992, 352 patients have undergone laparoscopic Heller myotomy and are followed through a prospectively maintained registry. Causes of ED visits and rehospitalization within 60 days after myotomy were determined. Patients scored their symptoms of achalasia before myotomy and at last follow-up; scores were compared to determine if the reasons leading to ED visits and/or rehospitalizations impacted long-term outcome after myotomy.
Results: 15 patients had 19 ED visits and 22 patients had 24 rehospitalizations within 60 days following myotomy (Table). 79% of ED visits were for dysphagia / vomiting and abdominal / chest pain, while 63% of rehospitalizations were for pulmonary / GI complications (Table). Pneumonia was complicated by empyema in 4 patients, all without leaks; 2 patients expired. Despite ED visits / rehospitalizations, achalasia symptom (e.g., dysphagia, regurgitation, choking, heartburn, chest pain) frequency and severity scores improved after myotomy (p<0.05 for all) (Table).
Conclusions: ED visits and rehospitalizations are infrequent following laparoscopic Heller myotomy. ED visits were due to complaints related to achalasia, while rehospitalizations were related to complications of operative intervention. Despite ED visits or rehospitalizations early after myotomy, symptoms of achalasia are well palliated by myotomy long-term.
Reasons for ED visits and Rehospitalizations

Reasons for ED Visits	# Visits	Reasons for Rehospitalization	# Visits
Vomiting / Dysphagia	10	Pneumonia	7
Abdominal / Chest Pain	5	Vomiting / Dysphagia	7
Unrelated	4	Pneumoperitonium	3
		Pneumothorax	2
		Ileus / Obstruction	2
		UGI Bleed	1
		Unrelated	2

	Patients With ED Visits (n=15)	Patients Rehospitalized (n=22)
Dysphagia Severity (preop vs follow-up)	(10, 9 ± 1.6) vs (3, 4 ± 3.1)*	(9, 7 ± 3.5) vs (1, 3 ± 3.1)*
Regurgitation Severity (preop vs follow-up)	(8, 7 ± 3.1) vs (1, 3 ± 3.8)*	(9, 7 ± 4.0) vs (0, 4 ± 6.1)*
Chest Pain Severity (preop vs follow-up)	(5, 5 ± 4.1) vs (1, 2 ± 2.6)*	(3, 4 ± 4.3) vs (0, 2 ± 3.1)*
Choking Severity (preop vs follow-up)	(9, 7 ± 3.9) vs (1, 3 ± 3.5)*	(9, 8 ± 3.0) vs (3, 4 ± 3.7)*

* Less at follow-up, p<0.05 Wilcoxon matched-pairs test. Data is presented as median, mean ± SD.