Laparoscopic Heller myotomy and robotic Heller myotomy: when is it indicated?

Abstract

Achalasia is a primary motility disorder of unknown origin. Palliative treatment is often adopted to resolve its symptoms by eliminating the resistance due to a non-relaxing and hypertensive lower esophageal sphincter. There are three available effective treatment modalities: pneumatic dilation, laparoscopic Heller myotomy with fundoplication, and peroral endoscopic myotomy. In choosing the proper treatment, it is important to remember that the esophagus lacks peristalsis in patients with achalasia. So once the lower esophageal sphincter is eliminated, reflux may occur with the potential of causing reflux symptoms, esophagitis, peptic strictures, Barrett’s esophagus, and cancer. For this reason, we believe that laparoscopic myotomy offers the best chance in most patients of improving esophageal emptying while protecting them from abnormal reflux.

Keywords

Achalasia / high-resolution manometry / Chicago Classification / pneumatic dilation / laparoscopic Heller myotomy / peroral endoscopic myotomy / gastroesophageal reflux / robotic surgery

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