Back to Annual Meeting Posters

Introduction: The surgical treatment of achalasia has evolved from a conventional laparoscopic Heller myotomy to a Laparo-Endoscopic Single Site (LESS) Heller myotomy with anterior fundoplication. This study illustrates our journey with the evolution in technology and instrumentation and details patient outcomes along our journey.
Methods: With IRB approval, patients were prospectively followed after Heller myotomy. Patients scored the frequency and severity of their symptoms before and after myotomy using a Likert scale (0=never/not bothersome to 10=always/very bothersome). The symptom frequency and severity of the first 100 patients undergoing laparoscopic Heller myotomy with anterior fundoplication were compared to the last 100 LESS patients undergoing LESS Heller myotomy with anterior fundoplication. Median data are reported.
Results: 601 Heller myotomies with fundoplications were undertaken between 1992-2012. Of these, 470 (78%) were completed via conventional laparoscopy, 130 (21%) via the LESS approach, and 1 (.1%) as an "open" operation. All of the last 100 patients underwent the LESS approach with anterior fundoplication. The frequency and severity of all preoperative symptoms significantly improved with either the conventional laparoscopic or LESS approach; several postoperative symptoms had superior improvement with the LESS approach (e.g., vomiting, choking, p=0.01 for each; Figures 1a, 1b). Those who underwent LESS Heller myotomy with anterior fundoplication also had a decreased length of hospital stay (2 vs. 1 day, p<0.05) and no apparent scars.
Conclusions: Laparoscopic Heller myotomy provides an efficacious and durable treatment for achalasia. The LESS technique offers a safe approach with equivalent or superior symptom relief and improved cosmesis. Overall patient satisfaction and durable symptom relief promotes laparoscopic Heller myotomy with anterior fundoplication, particularly using the LESS approach.

Graphs illustrate symptom frequency preoperative and postoperatively. Figure 1a is specific for the first 100 patients undergoing laparoscopic Heller myotomy with anterior fundoplication while Figure 1b is specific for the last 100 patients undergoing LESS Heller myotomy and anterior fundoplication.