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Eur J Cardiothorac Surg 2003;24:620-624
© 2003 Elsevier Science NL
Department of Thoracic Surgery, Royal Infirmary, Little France, Edinburgh EH16 4SA, UK
Received 10 November 2002; received in revised form 24 April 2003; accepted 23 June 2003.
* Corresponding author. Tel.: +44-131-242-3907; fax: +44-131-242-3930
e-mail: wsw{at}holyrood.ed.ac.uk
Objectives: Ideal treatment for achalasia permanently eliminates the dysfunctional lower oesophageal sphincter, relieving dysphagia and regurgitation. The aim of this study was to review the results in a series of patients undergoing video-imaged thoracoscopic Heller's myotomy (THM). Methods: Records of all patients undergoing THM by a single surgeon at one institution were analysed. Follow-up was conducted using a structured questionnaire together with oesophageal manometry and/or 24 h pH monitoring when clinically indicated. Results: Twenty-five consecutive patients (13 males, 12 females, mean age 40.3±19.9 years) suffering from grade 4 dysphagia underwent THM between 1993 and 2001. Preoperative mean lower oesophageal sphincter (LOS) pressure was 42.6±6.3 mmHg. Seven patients (28%) had undergone previous pneumatic dilatations. There were no hospital deaths and no oesophageal perforations. Length of hospital stay was 4.3±1.8 days. One patient died 3 years after surgery from unrelated causes. At follow-up of 5.4±2.1 years, freedom from any reintervention was 95.8% (23/24). Eleven patients (45.8%) were asymptomatic. In patients with residual or recurrent symptoms (n=13), their severity was significantly reduced from the preoperative period (dysphagia score 1.7±0.8 versus 4±0; P
0.05). Four patients (16%) with troublesome residual or recurrent grade 3–4 dysphagia underwent repeat oesophageal manometric study, showing a mean reduction in LOS pressure from their baseline values of 46.8±6.1 to 30±5.4 mmHg (P0.01). One of these patients (4.2%) required repeat Heller's myotomy 1.5 years after THM. Six patients complained of troublesome postoperative heartburn; distal oesophageal acid exposure was shown to be abnormal in 3 (12.5%) of these patients and all enjoyed symptomatic relief with medical therapy. Conclusions: THM is a safe and effective procedure in the treatment of achalasia. Some patients do experience recurrence of symptoms; however, these are significantly less severe. The incidence of postoperative heartburn is acceptably low and can be controlled with oral medications, making the addition of an anti-reflux procedure not necessary. Longer-term follow up and randomised studies comparing THM to other therapeutic modalities are needed to ascertain respectively the durability of this approach and its relative advantages.
Key Words: Achalasia • Video-assisted • Minimally invasive • Thoracoscopic • Heller's myotomy
This article has been cited by other articles:
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  N. Ma, H. Zhong, C. Ye, G. Shan, F. Zhang, and J. Mei Minimally Invasive Thoracoscope-Assisted Heller Myotomy for Achalasia Asian Cardiovasc Thorac Ann, December 1, 2008; 16(6): 459 - 462. [Abstract] [Full Text] [PDF]
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 D. Agrawal, L. Meekison, and W. S. Walker Long-term clinical results of thoracoscopic Heller's myotomy in the treatment of achalasia. Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 423 - 426. [Abstract] [Full Text] [PDF]
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