Efficacy and durability of robotic heller myotomy for achalasia: patient symptoms and satisfaction at long-term follow-up

Kyle A. Perry, Aliyah Kanji, Joseph M. Drosdeck, John G. Linn, Anthony Chan, Peter Muscarella, W. Scott Melvin

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Background: Laparoscopic Heller myotomy (LHM) has become the standard treatment for achalasia in the USA. Robot-assisted Heller myotomy (RHM) has emerged as an alternative approach due to improved visualization and fine motor control, but long-term follow-up studies have not been reported. We sought to report the long-term outcomes of RHM and compare them to those of LHM.

Methods: A retrospective cohort study was performed for patients who underwent laparoscopic or RHM between 1995 and 2006. Long-term follow-up was performed via mail or telephone questionnaire. The primary outcome measure was durable relief of dysphagia without need for further intervention. Secondary outcomes included gastroesophageal reflux symptoms, disease-specific quality of life, and patient satisfaction with their operation.

Results: Seventy-five patients underwent laparoscopic (n = 19) or robotic (n = 56) myotomy during the study period. Long-term follow-up was obtained in 53 (71 %) patients with a median interval of 9 years. RHM was associated with a decreased mucosal injury rate (0 vs. 16 %, p = 0.01) and median hospital stay (1 vs. 2 days, p < 0.01) compared to conventional laparoscopy. All patients reported initial dysphagia relief, and 80 % required no further intervention. This did not differ between groups. Sixty-two percent required medications to control reflux symptoms at long-term follow-up, including 56 % following robotic myotomy and 80 % after laparoscopic myotomy (p = 0.27). Overall, 95 % of patients were satisfied with their operation, and 91 % would choose surgery again given the benefit of hindsight.

Conclusion: There is a dearth of long-term follow-up data to support the effectiveness of RHM. This study demonstrates durable dysphagia relief in the vast majority of patients with a high degree of patient satisfaction and a low rate of esophageal mucosal injury. While a significant proportion of patients report reflux symptoms, these symptoms are well controlled with medical acid suppression.

Original languageEnglish (US)
Pages (from-to)3162-3167
Number of pages6
JournalSurgical endoscopy
Volume28
Issue number11
DOIs
StatePublished - Oct 21 2014
Externally publishedYes

Keywords

  • Achalasia
  • Heller myotomy
  • Laparoscopy
  • Robotic Heller myotomy
  • Robotics

ASJC Scopus subject areas

  • Surgery

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