Aim of study
Laparoscopic Heller’s myotomy is standard treatment for achalasia. The aim is to relieve the obstruction at the lower oesophagus and improve swallowing. We reviewed our patients treated for achalasia for long-term outcomes.
The case notes of patients from 2010-2017 presenting with a diagnosis of achalasia and having a Heller’s myotomy were reviewed. Demographic, operative and symptomatic factors with particular emphasis on long-term functional outcome were reviewed.
We performed laparoscopic Heller’s on 7 patients (6M, 1F). The median age at operation was 6.5 (4.7 – 15.4) years. The age of symptoms onset was 6 (3-13) years. Most patients had dysphagia alone or with vomiting. All had diagnosis confirmed by a contrast study and 1 had oesophageal manometry. All had an adequate laparoscopic Heller’s without fundoplication performed with no immediate postoperative complications.
Two patients had complete symptom resolution and were discharged after surgery (at 2 and 9 months). 1 had slightly improved dysphagia. 4 had initial symptom resolution, but after a median of 5.5 months (0.5-8) all 4 redeveloped symptoms of dysphagia alone (2), or with vomiting and odynophagia. All 5 had a postop contrast study at 7 months (1-9), which showed no improvement in 3 and improvement in 2 patients. A combination of prokinetic and antireflux agents had little benefit. 3 had an OGD with no narrowing seen, with dilatations in 2, and a normal impedence study in 2. Long-term follow-up at 4 (3-7) years showed 2 patients eating normally but with persistent symptoms, 2 on pureed diet and 1 being given psychological management for oral feed aversion.
In children Heller’s myotomy often has a poor functional result even though the obstruction is relieved by surgery. This is important in counseling patients before operation. A combination of psychological support and dietary management is often required.