Robotic Laparoscopic Lateral Heller Myotomy Without Fundoplication For Achalasia
Nabiha Atiquzzaman, Barbara Tempesta, Mark Meyer, Farid Gharagozloo, MD.
Florida Hospital Celebration Health/ University of Central Florida, Celebration, FL, USA.
Background: It is postulated that anterior Heller myotomy results in disruption of the Gastroesophageal valve (GEV), thereby resulting in wide open reflux and requiring an antireflux procedure. We hypothesized that a myotomy lateral to the GEV would leave the valve intact and obviate the need for an antireflux procedure. We sought to compare Robotic Laparoscopic Lateral Heller Myotomy without a Fundoplication (RLHM) to Robotic Laparoscopic Anterior Heller Myotomy with Dor Fundoplication (RAHM). Methods: We retrospectively studied patients with achalasia who underwent RLHM vs. RAHM . Patients were studied via 24-hour pH study and manometry at 6 months postoperatively. Dysphagia and GERD were final outcome variables. Pathologic GER was defined as distal esophageal time acid exposure time greater than 4.2% per 24-hour period. The outcome variables were analyzed on an intention-to-treat basis. Results: Thirty-eight patients were enrolled. There were no differences in the baseline characteristics between study groups. Median Postoperative dysphagia Score was 1 (range 0-1) with RLHM and 3 (range 0-4) with RAHM (P = 0.015). Pathologic GER occurred in 1of 24 patients (4.2%) after RLHM and in 2 of 24 patients (8.3%) after RAHM. Median Acid Exposure and Demeester Scores were similar when comparing RLHM to RAHM . Conclusions: The results of this study indicate that RLHM results in greater relief of dysphagia while preventing GER to the same level as RAHM.
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