Back to Annual Meeting Posters

Introduction: There are multiple surgical treatment options for Achalasia, with the laparoscopic approach increasingly considered the treatment of choice. We review the largest number of reported cases of laparoscopic Heller myotomies to date, from the NSQIP database, and compare alternative surgical treatments.
Methods: Using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) participant use files from 2005-2010, patients diagnosed with Achalasia (ICD-9 530.0) who underwent a surgical Heller myotomy, including open abdominal (CPT 43330), laparoscopic (CPT 43279), open thoracic (CPT 43331), and thoracoscopic (CPT 32665) approaches. As the CPT code for laparoscopic Heller myotomy was created in 2009, there are none reported before this time.
Results: A total of 978 patients diagnosed with Achalasia were identified, of which 663 patients received a laparocopic Heller, 239 open Heller, 16 open thoracic, and 60 thoracoscopic myotomies. Overall, 56.8% were male and mean age is 52 years (SD ± 16.3). There was no significant difference in age between groups. There was a significant difference in total length of stay between open and laparoscopy Heller myotomy groups only, 3.45 vs 2.48 days, p= 0.015. Operative time was significantly different between the open and laparoscopy Heller myotomy groups only, 146.0 vs 136.27min (SD ± 54.9), p 0.018. There only significant difference in postoperative complications was in superficial site infections, with 3 in open heller and 1 in thoracoscopic groups, p= 0.025. There were no deaths reported.
Conclusion: While there is no significant difference in serious post-operative complications, laparoscopic Heller myotomy has improved length of stay and operative times compared to open, and thoracic approaches.