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Laparoendoscopic single-site Heller myotomy with anterior fundoplication for achalasia

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Abstract

Background

Laparoendoscopic single-site (LESS) surgery is beginning to include advanced laparoscopic operations such as Heller myotomy with anterior fundoplication. However, the efficacy of LESS Heller myotomy has not been established. This study aimed to evaluate the authors’ initial experience with LESS Heller myotomy for achalasia.

Methods

Transumbilical LESS Heller myotomy with concomitant anterior fundoplication for achalasia was undertaken for 66 patients after October 2007. Outcomes including operative time, complications, and length of hospital stay were recorded and compared with those for an earlier contiguous group of 66 consecutive patients undergoing conventional multi-incision laparoscopic Heller myotomy with anterior fundoplication. Symptoms before and after myotomy were scored by the patients using a Likert scale ranging from 0 (never/not severe) to 10 (always/very severe). Data were analyzed using the Mann–Whitney U test, the Wilcoxon matched-pairs test, and Fisher’s exact test where appropriate.

Results

Patients undergoing LESS Heller myotomy were similar to those undergoing conventional laparoscopic Heller myotomy in gender, age, body mass index (BMI), blood loss, and length of hospital stay. However, the patients undergoing LESS Heller myotomies had operations of significantly longer duration (median, 117 vs. 93 min with the conventional laparoscopic approach) (p < 0.003). For 11 patients (16%) undergoing LESS Heller myotomy, additional ports/incisions were required. No patients were converted to “open” operations, and no patients had procedure-specific complications. Symptom reduction was dramatic and satisfying after both LESS and conventional laparoscopic myotomy with fundoplication. The symptom reduction was similar with the two procedures. The LESS approach left no apparent umbilical scar.

Conclusion

Heller myotomy with anterior fundoplication effectively treats achalasia. The findings showed LESS Heller myotomy with anterior fundoplication to be feasible, safe, and efficacious. Although the LESS approach increases operative time, it does not increase procedure-related morbidity or hospital length of stay and avoids apparent umbilical scarring. Laparoendoscopic single-site surgery represents a paradigm shift to more minimally invasive surgery and is applicable to advanced laparoscopic operations such as Heller myotomy and anterior fundoplication.

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Disclosures

Sharona Ross and Alexander S. Rosemurgy have received educational and research grants from Covidien Ltd., Olympus America Inc., and Stryker Corp. Linda Barry, Sujat Dahal, Connor Morton, Chinyere Okpaleke, and Melissa Rosas have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. The Center for Surgical Digestive Disorders, Tampa General Hospital, Tampa General Medical Group, 409 Bayshore Blvd, Tampa, FL, 33606, USA

    Linda Barry, Sujat Dahal, Connor Morton, Chinyere Okpaleke, Melissa Rosas & Alexander S. Rosemurgy

  2. Department of Surgery, Division of General Surgery, University of South Florida, 1 Tampa General Circle, Rm F-145, 33601, Tampa, FL, USA

    Sharona Ross

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  1. Linda Barry
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  2. Sharona Ross
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  3. Sujat Dahal
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  4. Connor Morton
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  5. Chinyere Okpaleke
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  6. Melissa Rosas
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  7. Alexander S. Rosemurgy
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Correspondence to Alexander S. Rosemurgy.

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Barry, L., Ross, S., Dahal, S. et al. Laparoendoscopic single-site Heller myotomy with anterior fundoplication for achalasia. Surg Endosc 25, 1766–1774 (2011). https://doi.org/10.1007/s00464-010-1454-7

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  • DOI: https://doi.org/10.1007/s00464-010-1454-7

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