Laparoscopic Heller Myotomy for Achalasia Technical Aspects

2018 ◽  
Vol 84 (4) ◽  
pp. 477-480 ◽  
Author(s):  
Francisco Schlottmann ◽  
Marco E. Allaix ◽  
Marco G. Patti
Keyword(s):  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Treatment Options ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Partial Fundoplication ◽  
Esophageal Peristalsis ◽  
Esophageal Motility Disorder ◽  
Esophageal Sphincter ◽  
Esophageal Emptying

Esophageal achalasia is a primary esophageal motility disorder defined by the lack of esophageal peristalsis, and by a lower esophageal sphincter that fails to relax in response to swallowing. Patients’ symptoms include dysphagia, regurgitation, aspiration, heartburn, and chest pain. Achalasia is a chronic condition without cure, and treatment options are aimed at providing symptomatic relief, improving esophageal emptying, and preventing the development of megaesophagus. Presently, a laparoscopic Heller myotomy with a partial fundoplication is considered the best treatment modality. A properly executed operation is key for the success of a laparoscopic Heller myotomy.

scholarly journals Achalasia: current therapeutic options

2017 ◽  
Vol 8 (6-7) ◽  
pp. 101-108 ◽  
Author(s):  
Zubin Arora ◽  
Prashanthi N. Thota ◽  
Madhusudhan R. Sanaka
Keyword(s):  
Esophageal Motility ◽  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Treatment Options ◽  
Motility Disorder ◽  
Pneumatic Dilation ◽  
Esophageal Peristalsis ◽  
Esophageal Motility Disorder ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Achalasia is a chronic incurable esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and loss of esophageal peristalsis. Although rare, it is currently the most common primary esophageal motility disorder, with an annual incidence of around 1.6 per 100,000 persons and prevalence of around 10.8/100,000 persons. Symptoms of achalasia include dysphagia to both solids and liquids, regurgitation, aspiration, chest pain and weight loss. As the underlying etiology of achalasia remains unclear, there is currently no curative treatment for achalasia. Management of achalasia mainly involves improving the esophageal outflow in order to provide symptomatic relief to patients. The most effective treatment options for achalasia include pneumatic dilation, Heller myotomy and peroral endoscopic myotomy (POEM), with the latter increasingly emerging as the treatment of choice for many patients. This review focusses on evidence for current and emerging treatment options for achalasia with a particular emphasis on POEM.

Long-Term Outcomes of POEM for Primary Esophageal Motility Disorders

2021 ◽  
Author(s):  
Christine Tat ◽  
Matthew Kroh
Keyword(s):  
Esophageal Motility ◽  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Laparoscopic Heller Myotomy ◽  
Esophageal Motility Disorders ◽  
Antireflux Procedure ◽  
Partial Fundoplication ◽  
Motility Disorders ◽  
Primary Esophageal Motility Disorders

AbstractSince peroral endoscopic myotomy (POEM) emerged in 2010 as a treatment for achalasia, more than 7,000 procedures have been performed in the world. The main indication for POEM continues to be achalasia, which is a rare esophageal motility disorder characterized by impaired lower esophageal sphincter relaxation and aperistalsis. POEM has also been applied in other types of primary esophageal motility disorders. Short-term outcomes indicate that POEM has comparable results to laparoscopic Heller myotomy in terms of efficacy and safety. Studies show decrease in Eckardt scores after POEM as a reflection of symptomatic relief. Now, a decade after its introduction, long-term data have emerged for POEM and demonstrates that POEM remains effective and safe. Both POEM and laparoscopic Heller myotomy are associated with postinterventional gastroesophageal reflux disease (GERD). Antireflux mechanisms are disrupted during the procedures. However, the rate of GERD is higher after POEM than with laparoscopic Heller myotomy. Laparoscopic Heller myotomy is commonly performed with a partial fundoplication to reduce antireflux, but POEM is not typically combined with an antireflux procedure. Further studies should examine the long-term effects of postinterventional GERD.

494 LONG-TERM SYMPTOM CONTROL FOLLOWING LAPAROSCOPIC HELLER MYOTOMY AND DOR FUNDOPLICATION FOR ACHALASIA

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
M Doubova ◽  
S Gowing ◽  
H Robaidi ◽  
S Gilbert ◽  
D Maziak ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Symptom Control ◽  
Laparoscopic Heller Myotomy ◽  
Dor Fundoplication ◽  
Esophageal Motility Disorder ◽  
Gerd Symptoms

Abstract   Achalasia is a primary esophageal motility disorder in which there is incomplete relaxation of the lower esophageal sphincter and absence of peristalsis in the lower two-thirds of the esophagus. A favored treatment is with laparoscopic modified Heller myotomy with Dor fundoplication (LHMDor) with over 90% beneficial effect. The short-term outcomes of LHMDor are well documented, but stability and durability of post-operative symptom control over time is less understood. Methods Between 2004–2016, 54 patients with achalasia underwent LHMDor (single center). Using validated questionnaires, patients rated their symptoms in five domains: pain, gastroesophageal reflux disease (GERD), dysphagia, regurgitation and quality of life (QOL), rating their symptoms preoperatively, 4-weeks post-operatively, 6-months post-operatively and yearly following the operation. Results As expected, patients reported marked improvement in dysphagia, odynophagia, regurgitation, GERD and quality of life after the operation (p < 0.001). From then on, the symptom control remained durable with respect to absence of pain, regurgitation and odynophagia; however, we observed a recurrence of GERD symptoms beginning 3–5 years postoperatively (p = 0.001, p = 0.04, respectively), with associated increased antacid use. Following initial LHMDor, 5 patients required endoscopic dilatation an average of 1.5 years post-operatively and no patient required reoperation. Patients reported preserved improved quality of life up to 11 years following the operation (p = 0.001). Conclusion These results demonstrate the durability of LHMDor in the definitive management of achalasia offering consistent symptomatic relief and significant improvement to QOL over the decade following surgery, despite some increase in GERD symptoms and antacid use.

scholarly journals Laparoscopic Heller Myotomy for Achalasia: Experience from a Single Referral Tertiary Center

2019 ◽  
Vol 11 (2) ◽  
pp. 90-97 ◽  
Author(s):  
Alireza Mirsharifi ◽  
Ali Ghorbani Abdehgah ◽  
Rasoul Mirsharifi ◽  
Mehdi Jafari ◽  
Noor Fattah ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Cross Sectional Study ◽  
Laparoscopic Heller Myotomy ◽  
Partial Fundoplication ◽  
Dor Fundoplication ◽  
Esophageal Motility Disorder ◽  
Cross Sectional ◽  
Retrosternal Pain ◽  
Tertiary Center ◽  
The Mean

BACKGROUND Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. METHODS In this cross-sectional study all patients undergoing LHM between 2015 and 2017 were studied. The myotomy was followed by an anterior or posterior partial fundoplication. All patients were followed up for at least six months. RESULTS We conducted this prospective study on 36 consecutive patients who underwent LHM over 3 years. The mean age of the patients was 36.64 ± 13.47 years. 30 patients (83.3%) underwent Toupet and 6 patients (16.7%) received Dor fundoplication. 11 patients (30.6%) developed reflux after the procedure. According to the Eckardt Symptom Scoring (ESS), the symptoms improved in 74.2% of the patients and remained unchanged in 25.8% of the patients. Analysis of the ESS, indicated a significant change in regurgitation and retrosternal pain, dysphagia, and weight loss after the surgery (p = 0.001, p = 0.002, p = 0.046, and p = 0.001, respectively). CONCLUSION LHM with anterior or posterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia, especially in patients who have not responded to other methods while no serious complication was reported despite several prior endoscopic interventions.

scholarly journals Laparoscopic Heller Myotomy and Dor Fundoplication for the Treatment of Esophageal Achalasia After Sleeve Gastrectomy—a Video Vignette

2020 ◽  
Author(s):  
Alberto Aiolfi ◽  
Diego Foschi ◽  
Marco Antonio Zappa ◽  
Alessandra Dell’Era ◽  
Emilia Bareggi ◽  
...  
Keyword(s):  
Sleeve Gastrectomy ◽  
Heller Myotomy ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Gastric Fundus ◽  
Esophageal Wall ◽  
Morbidly Obese ◽  
Obese Patients ◽  
Dor Fundoplication ◽  
Esophageal Motility Disorder

Abstract Purpose Esophageal dysmotility and disorders of the lower esophageal sphincter are well documented in morbidly obese patients. Esophageal achalasia has been reported in up to 1% of obese patients but the development of such esophageal motility disorder after laparoscopic sleeve gastrectomy (LSG) is extremely rare. The purpose of this video was to demonstrate the management of a type II esophageal achalasia diagnosed in a 46-year-old female patient 4-year after LSG. Materials and Methods An intraoperative video has been anonymized and edited to demonstrate the feasibility of laparoscopic Heller myotomy and anterior Dor fundoplication on the mentioned patient. Results The operation started with the section of the perigastric adhesions. Proceeding in a clockwise direction, the esophagogastric junction, the anterior esophageal wall, and the His angle were freed. A residual slightly dilated fundus was found and isolated. After mobilization of the distal esophagus and identification of the anterior vagus nerve, a “hockey stick” myotomy was carried out for 6 cm on the esophagus and for 2 cm on the gastric side. An anterior Dor fundoplication was fashioned using the residual gastric fundus. Conclusion Esophageal achalasia in patients that previously underwent LSG is exceptional but should always be suspected in case of pathognomonic symptoms onset. In tertiary referral centers, laparoscopic Heller myotomy and, if technically feasible, an anterior Dor fundoplication seem safe and effective to relieve gastroesophageal outflow obstruction and prevent gastroesophageal reflux.

POEM for Achalasia

2018 ◽  
Vol 84 (4) ◽  
pp. 489-495 ◽  
Author(s):  
Daniel A. Kroch ◽  
Ian S. Grimm
Keyword(s):  
Heller Myotomy ◽  
Randomized Trials ◽  
Treatment Algorithm ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Short Term ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter ◽  
New Treatment

In 2008, a new treatment modality for esophageal achalasia was introduced—peroral endoscopic myotomy (POEM). POEM is a procedure performed endoscopically, which allows transection of the muscular fibers of the distal esophagus and of the lower esophageal sphincter. The procedure is therefore similar to a laparoscopic Heller myotomy without a fundoplication. Short-term studies have shown that POEM is very effective in relieving dysphagia and regurgitation, but concerns have been raised about the incidence of post-POEM gastroesophageal reflux. Prospective and randomized trials will be needed to determine the role of this new procedure in the treatment algorithm of esophageal achalasia.

Laparoscopic Heller Myotomy versus Per Oral Endoscopic Myotomy: Evidence-Based Approach to the Treatment of Esophageal Achalasia

2018 ◽  
Vol 84 (4) ◽  
pp. 496-500 ◽  
Author(s):  
Francisco Schlottmann ◽  
Marco G. Patti
Keyword(s):  
Lower Esophageal Sphincter ◽  
Heller Myotomy ◽  
Esophageal Achalasia ◽  
Laparoscopic Heller Myotomy ◽  
Current Evidence ◽  
Success Rates ◽  
Per Oral Endoscopic Myotomy ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter ◽  
Per Oral

Esophageal achalasia is a rare disorder characterized by a failure of the lower esophageal sphincter to relax during swallowing, combined with aperistalsis of the esophageal body. Treatment is not curative, but aims to eliminate the outflow resistance caused by the nonrelaxing lower esophageal sphincter. Current evidence suggests that both laparoscopic Heller myotomy and per oral endoscopic myotomy (POEM) are very effectiveinthe reliefof symptoms in patients with achalasia. Specifically, for type III achalasia, POEM may achieve higher success rates. However, POEM is associated to a very high incidence of pathologic reflux, with the risk of exchanging one disease–achalasia–with another–gastroesophageal reflux.

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