Author(s): Gouda BP, Nelson T, Bhoyrul S
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Abstract Surgical myotomy is the gold standard in therapy for achalasia, but treatment failures occur and require revisional surgery. A MEDLINE search of peer-reviewed articles published in English from 1970 to December 2008 was performed using the following terms: esophageal achalasia, Heller myotomy, and revisional surgery. Thirty-three articles satisfied our inclusion criteria. A total of 12,727 patients, with mean age of 43.3 years (males 46\% and females 50\%), underwent Heller myotomy (open 94.8\% and laparoscopic 5.2\%). Revisional surgery was performed in 6.19\%. Procedures performed included revision of the original myotomy or creation of a new myotomy with or without an antireflux procedure or esophagectomy. Reasons for reoperation were incomplete myotomy (51.8\%), onset of reflux (34\%), megaesophagus (16.2\%), and esophageal carcinoma (3.04\%). Systematic review of the literature for revisional surgery following Heller myotomy revealed a 6.19\% rate of reoperation with a low mortality rate.
This article was published in Indian J Surg
and referenced in Surgery: Current Research