Introduction: Approximately 10-15% of patients undergoing minimally invasive esophagomyotomy for achalasia will require further surgical intervention for ongoing control of symptoms. The objective of this study is to review the outcomes of patients undergoing laparoscopic re-do Heller myotomy for recurrent or refractory symptoms in the setting of achalasia.
Methods: All patients undergoing laparoscopic re-do Heller myotomy were identified from 1992 - 2007. Outcome variables included perioperative morbidity and mortality, symptomatic improvement, and need for subsequent esophagectomy. Dysphagia was scored 1 (no dysphagia) to 5 (unable to swallow saliva).
Results: A total of 19 patients (10 men, 9 women) underwent laparoscopic re-do Heller myotomy for achalasia. The mean age was 49.3 years (range 23-80). Mean follow-up was 39.8 months. Median hospital stay was 3 days (range: 2-10), with no operative mortality or conversions to open. There were 3 complications (15.8%): 1 esophageal mucosal perforation that was repaired intraoperatively, 1 pneumothorax, and 1 case of chronic intraluminal mesh erosion subsequent to re-do Heller with cruroplasty. Immediate symptomatic improvement occurred in 89.5% of patients with the mean dysphagia scores improving from 3.4 to 1.8 (p=0.003). However during longer term follow-up, esophagectomy was ultimately required in 6/19 (31.6%) patients due to recurrent dysphagia.
Conclusions: Laparoscopic re-do Heller myotomy is safe and effective in the immediate improvement of dysphagia in nearly 90% of patients. On longer term follow-up, approximately two-thirds of patients remain free of subsequent surgical intervention. Further prospective studies with longer follow-up are required to identify the factors affecting the outcome in these patients.